Evidence-Based Practice Project Paper on Diabetes

According to the article, A Type 1 Diabetes Genetic Risk Score Can Aid Discrimination between Type 1 and Type 2 Diabetes in Young Adults, by Oram et.al (2015), the increase in obesity has made it challenging to differentiate between type 1 and type 2 diabetes among young adults. The scholars explain that there have been developments trying to recognize the influence of genetic variants associated with type 1 and type 2 diabetes. The focus of the study was to identify if a score could be obtained from the usual genetic variants that could be employed to distinguish between type 1 and type 2 diabetes in addition to predicting deficiency of insulin among the young individuals who have diabetes (Oram et.al, 2015).

It is perceived that the autoimmune of the type 1 diabetes may take places when one is older. Nonetheless, with the increase in a number of people affected by obesity, a large number of young adults are acquiring type 2 diabetes and that most of the young people with type diabetes have a high risk of obtaining obesity (Bingley, 2010). It is, therefore, important to identify the accurate diagnosis since the treatment accorded to each type tends to be different. The scholars explain that individuals with type 1 diabetes need the provision of insulin treatment as the pancreatic b-cells that produce insulin tend to be demolished through the autoimmune process. It is important to note that immense deficiency of insulin leads to increase in variability of glycemic and the need for treating the deficiency with the exogenous insulin. The treatment incorporates additional agencies such as the counting of carbohydrate and rigorous treatment of insulin. Type 2 diabetes emanates from a slow decrease in the function of the b-cell during the resistance of insulin (Bingley, 2010). The early management of the condition entails adequate management of diet and if need be, therapy by using the oral hypoglycemic agents. About fifteen percent of young people with diabetes receive the wrong diagnosis or classifications such that they receive the wrong treatment. Farmer & Fox (2011) assert that the first diagnosis tends to be unsystematic and that once it is carried out, it is not easily rectified and hence an individual receiving treatment for the wrong illness. The mistaking of type 2 diabetes such that one is considered to have type 1 diabetes brings about the treatment using insulin which is irrelevant such that an individual experience several side effects and incurs plenty of unnecessary costs. Also, misdiagnosing type 1 diabetes such that one is considered to have type 2 diabetes brings about inadequate control of glycemic, frequent visits to the hospital to obtain treatment as a result of the increased demand for care in addition to increased risks of obtaining ketoacidosis which tends to be life-threatening (Farmer & Fox, 2011).

It is perceived that the existing diagnostic tests that are used in assessing the subtypes of diabetes tend to have several limitations. It is perceived that the presence of autoantibodies such as IA-2, GAD, ZnT8 and IAA may assist in recognizing the subtype of diabetes that is affecting an individual (Palmer & Hirsch, 2003). Nonetheless, the autoantibodies tend to be unreliable in regards to; a thorough assessment of antibodies does not normally take place in the clinical surrounding, the autoantibodies may also occur in type one diabetes; the positivity of the islet autoantibody tends to be low among people with type one diabetes if the assessment was made after diagnosis, and that positivity of the islet autoantibody tends to be low among people with type 1 diabetes when they were found to have the condition when they are adults rather than when they were children (Palmer & Hirsch, 2003). Oram et.al (2015) state, The measurement of endogenous insulin (using either serum or urine C-peptide) can accurately distinguish between T1D and T2D outside of the honeymoon period (9, 10), but its use is more limited at diagnosis.

According to findings by Oram et.al (2015), the GRS, which refers to the total number of alleles that increase the risks in acquiring a sickness. From the scholars viewpoint, a GRS may be effective in the discrimination of type 1 diabetes and type 2 diabetes due to the presence of usual SNPs. Also, the type 1 diabetes GRS may assist in recognizing people who have a high risk of developing an immense deficiency of insulin especially among young people with onset diabetes. Oram et.al (2015) states, The discriminative ability of the T1D GRS is independent of and additive to that of islet autoantibodies, BMI, and age at diagnosis. The T1D GRS is, therefore, a potentially important additional tool to help classify diabetes subtypes in young adults with diabetes. The type 1 diabetes GRS is viewed to contain several benefits. One of the benefits is that it does not rely on the period of time after diagnosis has been conducted with the view that the genome of a person does not exhibit any changes after some time. The view is in comparison with the autoantibodies whereby their ability to discriminate decreases with time after the diagnosis has been conducted. Another benefit is that genotyping regarding SNP tends to be less complex and precise. The third benefit is that SNPs genotyping includes fewer costs since it only requires sampling of blood and the extraction of DNA (Oram et.al, 2015).

References

Bingley, P. J. (2010). Clinical applications of diabetes antibody testing. The Journal of Clinical Endocrinology & Metabolism, 95(1), 25-33.

Farmer, A., & Fox, R. (2011). Diagnosis, classification, and treatment of diabetes. BMJ, 342.

Hamman, R. F., Bell, R. A., Dabelea, D., DAgostino, R. B., Dolan, L., Imperatore, G., ... & Pihoker, C. (2014). The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes care, 37(12), 3336-3344.

Oram, R., Patel, K., Hill, A., Shields, B., McDonald, T., & Jones, A. et al. (2015). A Type 1 Diabetes Genetic Risk Score Can Aid Discrimination Between Type 1 and Type 2 Diabetes in Young Adults. Diabetes Care, 39(3), 337-344. http://dx.doi.org/10.2337/dc15-1111Palmer, J. P., & Hirsch, I. B. (2003). Whats in a name? : Latent autoimmune diabetes of adults, type 1.5, adult-onset, and type 1 diabetes. Diabetes Care, 26, 536538.