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Well presented and argued poster, with content accurate and relevant.  correct APA referencing . Well done.
Marked by Aleria Harrold

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correct APA format, with a variety of sources utilised.

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Good use of recent statistics

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well presented and support argument.

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(Farrell & Dempsey, 2014).

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(Diabetes Australia, 2015a).

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(Farrell & Dempsey, 2014; Golden, 2011).

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A metabolic disorder consisting of genetic abnormalities including beta cell function, proinsulin and insulin molecular structures, insulin receptors, hepatic synthesis of glucose, glucagon synthesis and cellular response to insulin stimulation (Huether & McCance, 2012).

Abnormalities combined with environmental factors results in insulin resistance and decreased insulin secretion by beta cells, causing hyperglycaemia (Huether & McCance, 2012).

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(WebMD, 2014).

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The statement that co-morbidities and mortality are most effectively prevented through blood pressure lowering strategies in Australians with Type II Diabetes, is not adequately supported by evidence and therefore is not an agreeable position. Preventing mortality and co-morbidities that result from both microvascular and macrovascular complications, requires interventions of a multifaceted approach and that are tailored to the individual person (Colagiuri, 2014; Deedwania, 2011; Kirsh & Aron, 2011). The management of diabetes should not only involve the control of blood pressure, it also requires the regulation of blood glucose and lipid levels as primary interventions in order to be effective in reducing the risk of such complications (Colagiuri, 2014; Kirsh & Aron, 2011; Yudkin, Richter, & Gale, 2011).

An approach that only incorporates a single intervention will work towards preventing some of the complications associated with Type II Diabetes but will fail to address the others. For example, evidence suggests that by lowering blood pressure and blood lipids will primarily reduce the risk of macrovascular complications, whereas it won’t have a significant effect on microvascular complications (Kirsh & Aron, 2011). In contrast, control of blood glucose levels significantly reduces the risk of microvascular complications more so then the macrovascular ones (Mitka, 2013; Neugebauer, Fireman, Roy, & O’Connor, 2013; Shahady, 2011; Yudkin et al., 2011). As both microvascular and macrovascular complications are leading causes to developing co-morbidities and the subsequent reduction in mortality, it is evident that any treatment should be an approach that aims to reduce both (Colagiuri, 2014; Gunton, Cheung, Davis, Zoungas, & Colagiuri, 2014; Ismail-Beigi, 2011). In addition to managing blood pressure and glucose is to also address blood lipid levels as these are shown to have an effect on both microvascular and macrovascular complications (Twigg & Wong, 2015).

Uncontrolled blood lipid levels and glucose levels give rise to a greater risk of conditions including vascular disease, nephropathy and retinopathy (Adnan, Shabbir, Ali, Ali, & Rahat, 2013; Fowler, 2011). A pathological process called artherosclerosis plays a central role in vascular disease as it is responsible for the narrowing of arterial walls and is promoted by elevated blood lipid levels (Dixon et al., 2014; Fowler, 2011). Similarly, high blood glucose levels, a condition called hyperglycemia, is strongly linked to inducing cell damage to organs such as the kidneys and eyes (Fowler, 2011). By targeting blood pressure alone, diabetic complications such as these would not be treated and would lead to such co-morbidities and in turn affect mortality.

In Australia, co-morbidities in relation to Type II diabetes account for 9% of deaths annually (Haji Ali Afzali, Gray, Beilby, Holton, & Karnon, 2013). Owing to the fact that not all patients suffer from hypertension, there is evidence to suggest that blood pressure lowering strategies alone are not effective in preventing co-morbidity and mortality in Type II diabetes, and that a range of lifestyle interventions in conjunction have the most positive effect (Aksnes, Skarn, & Kjeldsen, 2012; Gunton et al., 2014; Haji Ali Afzali et al., 2013; Sattar, 2014).

Lifestyle interventions such as a nutritionally balanced diet and increased physical activity have shown to effectively reduce co-morbidities such as metabolic parameters, and blood pressure levels in relation to Type II Diabetes (Deedwania, 2011; Unger, Hinnen, Schreiber, & Parkin, 2013; Hordern et al., 2012). An individualised patient focused plan with an emphasis on an increase in physical activity and dietary modification has shown to have lasting effect in decreasing the incidence of a range of co-morbidities and risk factors such as kidney disease, hypertension, and micro and macrovascular complications, due to the focus on overall health (Schellenberg, Dryden, Vandermeer, Ha, & Korownyk, 2013). The broad spectrum of co-morbidities decreased with this treatment plan could not be achieved with a sole blood pressure lowering strategy due to the sole focus on one health concern, and therefore this strategy does not have the most positive impact (Tuomilehto, Schwarz, & Lindstrom, 2011; Zheng et al., 2012).

It is evident that focus on blood pressure lowering strategies alone would lead to serious contributing factors such as obesity and poor nutrition going untreated, thus leading to the development of significant co-morbidities, and mortality (Hordern et al., 2012; Schwarz, Greaves, Lindstrom, Yates, & Davies, 2012). In comparison, a lifestyle intervention program has proven to take into account the prevention of modifiable risk factors including hypertension, as well as successfully showing a long lasting decrease in the incidence of additional co-morbidities, and in the long term, mortality (Johnson et al., 2015; Kahn, Cooper, & Del Prato, 2014).

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It has been well documented that optimisation of blood pressure (BP) levels is associated with reducing both microvascular and macrovascular complications, thereby supporting the perspective that BP lowering strategies does have a significant impact in preventing co-morbidity and mortality in Type II Diabetes (Long & Dagogo-Jack, 2011). Hypertension is a well-established and modifiable risk factor for all major cardiovascular events, significantly influencing the development and progression of microvascular and macrovascular complications within diabetic patients (Parati, Bilo, & Ochoa, 2011). It is therefore of primary importance to implement strategies which focus on managing major risk factors, in an attempt to ensure prevention and improve patient outcomes (Deedwania, 2011; Long & Dagogo-Jack, 2011; World Heart Federation, 2015).

Research shows that Cardiovascular Disease (CVD) is the leading cause of death within Australia and that individuals with Type II Diabetes are at a 2-5 fold increase of experiencing a cardiovascular event (Golden, 2011; Kennedy & Roberts, 2013; Nathan, 2015). The Australian Bureau of Statistics recorded an increase of 37.5% of deaths with Type II Diabetes as the underlying cause and of these deaths, macrovascular conditions such as ischaemic heart disease and hypertension were listed as the main cause (Australian Bureau of Statistics, 2015).  This strongly emphasises the significance of preventative practices in controlling major co-morbid risk factors in patients with diabetes and hypertension (Long & Dagogo-Jack, 2011).

Management strategies for Type II Diabetes have focused heavily on long term glycaemic control, which has demonstrated positive effects on reducing microvascular complications and also in reducing CVD in Type I Diabetes. Despite this, there have not been any long-term, controlled studies showing a decrease in macrovascular complications from intensive glycaemic control (Farrell & Dempsey, 2014; Fowler, 2011; Golden, 2011; Nathan, 2015). However, more recent studies have indicated that the modification of other elements, including lowering BP and cholesterol levels has effectively reduced co-morbidity and mortality in patients with Type II Diabetes (Farrell & Dempsey, 2014; Fowler, 2011; Nathan, 2015). This treatment shows that by targeting major risk factors, there have been significant reductions in co-morbidity and mortality for individuals with Type II Diabetes, also with benefits occurring within a short period of time (Campbell et al., 2011).

This is further demonstrated in a study of 11,140 patients over the age of 55 with Type II Diabetes  (Shah et al., 2011; Zoungas et al., 2014). This study indicated that BP lowering treatment resulted in long term benefits and reduced mortality from cardiovascular or other causes, as opposed to the patients receiving intensive glucose control that did not result in any long term benefits relating to macrovascular events (Shah et al., 2011; Zoungas et al., 2014).  In fact, a study of patients undertaking intensive glycaemic therapy was ceased early due to an increased rate of mortality as a result of macrovascular events (Golden, 2011; Shah et al., 2011).  This suggests that therapy focusing largely on intensive glycaemic control may not only be less beneficial but potentially harmful.

As highlighted, hypertension is a prominent co-morbidity within Type II Diabetes and is defined as a rate of >140/90 mm Hg (Campbell et al., 2011). Current guidelines suggest that the goal of treatment is to obtain a controlled BP of <130/80 mm Hg (Fowler, 2011; Grossman & Messerli, 2011). Within the Hypertension Optimal Treatment Study, evidence indicated that lowering diastolic BP to <80 mm Hg compared to those reduced to a target of <90 mm Hg, resulted in a 51% reduction in major cardiovascular complications (Grossman & Messerli, 2011). Further research also demonstrated that each 10 mm Hg decrease in systolic BP was associated with a 12% reduction in risks of all co-morbid complications related to Type II Diabetes (Golden, 2011; Grossman & Messerli, 2011). It was found that in addition to many individuals having co-existing hypertension, any given systolic BP in patients with diabetes is associated with more than a 2-fold increase. For example, a systolic BP between 120 and 139 mm Hg in those with diabetes had a similar mortality rate in CVD as a patient without diabetes whose systolic BP was 160 to 179 mm hg (Campbell et al., 2011; Grossman & Messerli, 2011).

The evidence presented clearly demonstrates that high blood pressure levels increases the risk of cardiovascular events, which is the the leading cause of co-morbidity and mortality in diabetic patients (Golden, 2011; Kennedy & Roberts, 2013; Nathan, 2015).  Medical management with an emphasis on reducing blood pressure decreases macrovascular disease, lowering the risk of potentially harmful cardiovascular events and therefore must be considered a critical strategy of Type II Diabetes management.

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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

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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

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As discussed above, Type II Diabetes impacts the lives of diagnosed individuals immensely due to both macrovascular and microvascular complications, therefore nurses have a large range of aspects to care for in order to prevent these from resulting in co-morbidities (Colagiuri, 2014; Gunton et al., 2014). Many studies have been carried out that discuss the implications of incorporating only one nursing intervention and the increased risk this leaves the patient with; a higher chance of developing co-morbidities and an increased chance of mortality occurring (Colagiuri, 2014; Esterman et al., 2016). Therefore multiple interventions are essential to result in the desired outcome including but not limited to; monitoring blood lipid and glucose levels, pharmacological treatment, blood pressure management and diet and lifestyle regimes (Deedwania, 2011; Gunton et al., 2014; Haji Ali Afzali et al., 2013; Sattar, 2014; Unger et al., 2013). It has been clearly established that the use of lowering blood pressure strategies on their own will insufficiently prevent these discussed co-morbidities and decrease mortality rates; therefore we disagree with the topic statement.

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                          Current Figures and Statistics

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                          Current Figures and Statistics

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Currently, an estimated 1.5 million Australians are diagnosed with Type II Diabetes (Johnson, Martin, & Timoshanko, 2015).

Prediction of diagnosis to 3.3 million by 2031 (Johnson, Martin, & Timoshanko, 2015).

100,000 Australians per year develop diabetes / 280 people every day (Diabetes Australia, 2015b).

If not managed, Type II Diabetes can lead to co-morbidities (Johnson, Martin, & Timoshanko, 2015).

Figures are based on self reporting methods, therefore it is likely the figures are underestimated due to cases being unreported or undiagnosed (Australian Institute of Health and Welfare, 2016).