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Healthcare Policy and Delivery System


The paper investigates the necessity of establishing government-controlled educational programs on lifestyle changes among people suffering from diabetes on an obligatory and regular basis. The paper provides problem statements that evaluate current problems that are relevant to patients with diabetes. The literature review provides an overall understanding of the origins of the disease as well as its symptoms, which form the background for the evaluation of proposals. The proposal for change provides an understanding of the educational programs for people with diabetes and more detail on how this program should be implemented.

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Moreover, this part suggests the creation of a video game, which would help both adults and children in finding solutions for particular lifestyle problems. The paper also provides an understanding of the benefits and cost-effectiveness of the program, as it is supposed to reduce the number of hospitalization cases among people with diabetes. The essay explains why the need for special programs conducted by professional nurses for people with diabetes is significant, as the knowledge could make the quality of life higher and could decrease the level of hospitalization cases among the insulin-dependent people.

Keywords: diabetes, program, lifestyle, diabetes mellitus


Diabetes is a chronic disease, which is connected to high blood glucose. Apart from hyperglycemia - high blood sugar, an essential feature of uncompensated diabetes is glycosuria - glucose excretion in the urine (Ahmad, 2013). Diabetes is not a modern disease, as many believe. In fact, it is deeply rooted in history. For the first time, diabetes is mentioned in ancient Roman documents dating back to the times of the Roman empire (Ahmad, 2013). Diabetes can develop at any age, so anyone can be in the group of risk (DeFronzo, Ferrannini, Zimmet, & Alberti, 2015).

The quality of life in patients with diabetes varies greatly because it is vital not to miss the time of the injection for insulin-dependent patients. Therefore, every patient is responsible for their own life, and nurses can not gain influence on this aspect of their disease. The need for special programs conducted by professional nurses aimed at people with diabetes is significant, as the knowledge could make the quality of life higher and could decrease the level of hospitalization cases among the insulin-dependent people.

Problem Statement

Diabetes mellitus is an endocrine disease, and it is characterized by a chronic increase in blood sugar levels due to the absolute or relative deficiency of insulin, also known as the pancreatic hormone (DeFronzo et al., 2015). The disease leads to disruption of all types of metabolism, vascular damage, nervous system problems, and other organs and systems deviations. It is possible to live a full life with diabetes if the patient is ready to pay attention to their health issues and react to their body’s state. It is necessary to eat properly and inject insulin in time, choose adequate doses of medicine to control blood sugar, etc. (Poretsky, 2010). The fact that this life is more difficult than that of an average person is undeniable, but at the same time, there is the possibility to live life with joy and comfort if operating relevantly.

Without education, it is practically impossible to achieve the ability to manage the disease effectively. Moreover, without the unattainable metabolic compensation and prevention of complications, it would be impossible for the patient to live a long and full life. Suffice it to mention the fact that patients who have never taken part in the training are four times as likely to develop complications as compared to those who underwent training in any form. Over the years of living with diabetes, the patient's condition and their needs change significantly, and training must conform to these changes, as it should be a prolonged process and not just a single health effect.

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Literature Overview

Diabetes as translated from Greek means "pass-through," i.e. water is not retained in the body (DeFronzo et al., 2015). Moreover, for many hundreds of years, scientists and doctors have been trying to find out what the causes of diabetes are to prevent the development of this disease in future generations and find a cure to help the already ailing. However, the ones who were already sick were doomed (DeFronzo et al., 2015). At the beginning of the 20th century, scientist Langerhans discovered special cells of the pancreas - the beta cells responsible for insulin synthesis (DeFronzo et al., 2015).

These cells are arranged in groups, which are named after the scientist who discovered them – the islets of Langerhans (DeFronzo et al., 2015). The discovery of these cells was followed by a series of experiments, which in 1921 made it possible to allocate a substance called insulin from these beta cells (DeFronzo et al., 2015). The discovery of insulin was the beginning of a new era in endocrinology, and diabetes patients got a chance to live a fuller life than before the discovery of the cure.

A number of serious complications, which greatly deteriorate the quality of life among patients and can lead to premature death, accompany diabetes (Goldstein & Mueller-Wieland, 2016). In this regard, in recent decades, the use of unconventional approached to the assessment of the efficiency of medical care in various diseases has increased, based on an assessment of the quality of life including health-related factors (Ahmad, 2013). Since any chronic pathology has a direct impact on individual patients, it is likely that a difficult physical illness, such as diabetes, also has an impact on the personal characteristics of a person and significantly affects the quality of life of the patient (Goldstein & Mueller-Wieland, 2016).

The presence or absence of illness is one of the most important factors determining the quality of life, as well as the psychological and emotional states of patients. Negative attitudes to diabetes and unstable emotional states can lead to the patient's inability to adequately assess the psychological aspects and overcome the current situation in terms of illness (Goldstein & Mueller-Wieland, 2016). The patient with such a diagnosis sees diabetes as a lifelong threat that cannot be eliminated due to the nature of the disease and which will necessarily lead to serious consequences. This perception of life inevitably leads to a deterioration of emotional state, accompanied by an increase in anxiety and depression (Poretsky, 2010).

Often, depression among patients with diabetes is a stronger prerequisite of such health outcomes as hospitalization and mortality than physical and metabolic factors, the increase of the body mass index, the level of glycated hemoglobin, and the presence of other complications (Bilous & Donnelly, 2010). Thus, the level of quality of life is one of the defining factors in the patient's ability to manage their illness and daily well-being in the physical, psychological, and social aspects of life, which is significant for children and adolescents who have to live with diabetes for many years (Poretsky, 2010).

At present, all over the world schools are established to operate actively help and operate on patients with chronic hepatitis, asthma, hypertension, and other diseases (Bilous & Donnelly, 2010). However, training of patients with diabetes mellitus was the first example of an integrated approach to chronic disease treatment. The aim of education is not simply to ensure that patients possess the necessary information. It also needs to lead to a gradual and progressive change in their own ideas about the disease and treatments. The achievement of the maximum ability to control diabetes in a timely manner solves various problems in life. It can only be gained through patient awareness about all aspects of the disease (Poretsky, 2010).

It should be noted that diabetes is not only a chronic and potentially disabling disease, but can also require large costs for its treatment. Thus, this disease is a medical, social, and economic problem (Bilous & Donnelly, 2010). That is why the problem of overcoming the increasing incidence of diabetes in the country is impossible without the joint efforts of state bodies, public organizations, pharmaceutical companies, medical practitioners, endocrinologists, and, of course, patients with diabetes themselves.

Proposal for Change

Currently, the situation is such that for the effective treatment of chronic diseases, patients should take responsibility for their health. This is only possible if patients are properly trained in how to constantly control their disease. Thus, the additional role for the successful treatment of chronic diseases among health care workers is to educate patients. Currently, patient education is mandatory and an integral part of the treatment of diabetes of any type. Therefore, the establishment of the programs of education on lifestyle changes among people with diabetes should be conducted on the obligatory regular basis and controlled by the Government.

As such, it would help to make the life of patients with diabetes easier and happier. Moreover, such programs would help nurses to educate their patients on all the necessary issues, which would reduce the amount of hospitalization in the future. The law amendment for the obligatory performance of such programs would work for the benefit of the diabetic population as a whole.

The aim of educating people with diabetes is the formation of motivation of patients to receive treatment, so that they can take an active part in the process, as well as the acquisition of practical knowledge and skills required for adapting to the qualitatively new conditions of life. The peculiarity of diabetes treatment is that the patient should carry out a complex treatment by themselves. To do this, they must be knowledgeable in all aspects of the illness and be able to change the treatment depending on particular situations.

In order to achieve this ultimate goal of training programs, it should be drawn up according to the rules of pedagogy and psychology. These programs should be divided into academic units with clear regulation of the scope and sequence of presentation, as well as the formulation of educational objectives for each training unit. The program should contain a required set of visual aids and teaching techniques aimed at assimilation, repetition, and reinforcement of knowledge and skills. Learning efficiency becomes satisfactory only if the systematic training plan complexity generally lasts for at least 15 hours.

One of the objectives of training patients is the formation of new motivation and attitudes so that they could take over a large part of the responsibility for the competent self-treatment of the disease and change their behavior associated with diabetes. Consequently, the focus of training programs should be strictly practical, corresponding to the principle of reasonable sufficiency. The pathogenesis of diabetes in medical terminology affects the extent to which it is directly related to the treatment (Poretsky, 2010).

Patient education has nothing to do with simple lectures. After lecturing, an expert does not receive direct information about whether students reach the learning objectives. Classes with patients must be conducted in the form of conversation. In order to involve patients in the active work of the classroom, teaching staff must find personal approached to each of them. A favorable psychological status of the patient's diabetes management can be better provided by a highly practical orientation of training, which takes into account their specific daily needs. In addition, these patients would benefit from regular support of medical specialists, along with traditional counseling and the one conducted with the help of computers and mobile phones that is currently becoming more and more affordable.

The particular importance of the training programs is their aim at involving people with diabetes in an active and constructive discussion of the status and experiences of living with the disease. Given the increasing popularity of social networking, interactive communication and support should take place not only in specialized offices but also on-line. It is recommended to create an interactive game space, where, while performing simple tasks, the patient will be able to explore different life situations and find a way to deal with them.

The principles of pedagogy and psychology should be taken into account while developing this educational game. Game space allows a greater degree of freedom than a standard structured program. The current method focuses on lifestyle changes of the patients and their responsibilities, as well as sets specific targets as a means to achieve the best results. Moreover, it is suitable not only for adults but also for children.

For nurses, these programs will also have special professional and moral significance. The ability to see specific problems of patients, possession of adequate language feedback in communication, and other aspects make the daily practice of the management of patients with diabetes easier. Moreover, it facilitates the working quality of nurses and saves time.

Therefore, the governmental program of education on lifestyle changes among patients with diabetes should apply for control of acquired knowledge, used by themselves as the primary means of training. The patients would be able to form new motivations and behavior changes. This is a fundamental difference between the treatment and training programs for patients, as programs have the responsibility to teach the Diabetic Population how to enjoy life even while having such a disease.

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Cost and Benefit Analyses

Education of patients with diabetes is not only practical but also contributes to the scientific field of diabetes study. The effectiveness of this therapeutic effect must be assessed according to the rules of evidence-based medicine (Jacobs-van der Bruggen, van Baal, Hoogenveen, Feenstra, Briggs, Lawson, Feskens, & Baan, 2009). At the same time, it goes beyond standard medical interventions and requires mandatory registration of psychosocial context. It should be noted that the effect of education can be obtained only if it is carried out by specialists who have received training and possess skills in the field of pedagogy and psychology (Jacobs-van der Bruggen et al., 2009).

Lack of trained professionals is considered a serious problem in training, as well as the presence of training programs that fail to measure performance. The main therapeutic target for diabetic patients with obesity is its reduction. Achieving this objective in the current set reference period would prove the effectiveness of the program. The increase in blood pressure, especially the systolic kind, is a significant risk factor for macrovascular complications. Education can yield positive results for the correction of blood pressure, especially if patients are using specialized software.

The cost-effectiveness analysis should be conducted through special techniques, as it allows comparing the costs and savings for different methods of treatment of any pathology (Jacobs-van der Bruggen et al., 2009). If consider the costs and savings related to health care only, while the overall savings become noticeable in the first years, even taking into account the value of self-control, which indicates a greater economic efficiency of treatment programs and education as compared to traditional approaches. The results of the program should increase awareness among the Diabetic Population about the origins of the disease. They should know the basics of diabetes, self-control, and motivation for the improvement of lifestyle. The program should form the awareness of the possibility of happy and joyful living even when having chronic a disease.

The government would experience the benefits of the program too. Education should help reduce the number of hospitalization cases, as the patients would have the possibility to control disease and avoid critical situations. Consequently, the expenses on medicine for the reanimation of the patient and on the salaries of medical staff would also decrease. In cases with pharmaceutical treatments, the effect is only observed while the patient is taking the medication (Jacobs-van der Bruggen et al., 2009). Upon termination of the drug, all the positive effects of treatment are lost, and the cost of correcting the consequent imbalance increases (Jacobs-van der Bruggen et al., 2009).

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When adjusting the lifestyle of the patient, the continuation of effects is evident even after the end of the program. Thus, the health benefits will be prolonged, and the maintenance costs will be reduced significantly because the patient will not need expensive medical treatments (Jacobs-van der Bruggen et al., 2009). Moreover, the launch of such programs would provide nurses with spare time, as the number of patients in hospitals would reduce. Therefore, the programs prove their effectiveness and significance both for patients and nurses.


Education about diabetes has a multifaceted therapeutic effect, which goes beyond simply informing patients about the features of the disease, the formation of skills of regular self-monitoring of blood glucose, and the continuous reception of prescribed medication. Thus, to improve the effectiveness of training, it is necessary to identify and take into account the psychological characteristics of patients. The program suggests the development of special computer software, which in the form of a game would help the patients with diabetes find the solutions for their lifestyle problems.

In addition, psychotherapy would be very useful in the program too, as endocrinology could not solve all the issues experienced by patients. Summarizing the above, the current training connected to diabetes acts as a basis for treatment but does not improve the lifestyle of patients. One of the immediate measures to improve the medical care of patients with diabetes in the state of Florida should be the introduction of a comprehensive assessment and structured programs for treatment and patient education. These programs would affect both patients and nurses as the level of hospitalization would reduce, which would work for the benefit of both groups.

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