Role of the Family Nurse Practitioner in the Management of Type 2 Diabetes Mellitus

Abstract

Type 2 diabetes mellitus is a leading chronic illness worldwide and a significant cause of disability and premature death. Once a disease of the elderly, it is increasingly prevalent in adolescents. Most patients do not attain glycemic control, resulting in a myriad of complications, despite being both highly preventable and treatable. A lackluster approach to management has contributed to the gross undertreatment of diabetes. As the family nurse practitioner presence in primary care grows, we inherit responsibility for this disease and its sequelae. A discussion of current evidence-based prevention and management strategies follows.
Keywords: type 2 diabetes mellitus, family nurse practitioner, primary care, prevention, treatment, undertreated disease

Background


Type 2 diabetes mellitus (T2DM) is a highly preventable and treatable metabolic condition. Fundamentally, it is disorder of chronic hyperglycemia, which serves as a central cause of illness, decreased quality of life, and premature death. The disease is progressive in nature, yet its trajectory will vary by individual, extent of risk factors, and adequacy of treatment. While it is well-established T2DM significantly increases morbidity and mortality, it is among the most inadequately managed chronic illnesses worldwide. Up to one-half of patients do not achieve or maintain glycemic goals.1 Hectic clinic schedules, weary providers, and lack of knowledge are thought to create a disparity in the care of diabetic patients, who are often undereducated, poorly monitored, and grossly undertreated.

National diabetes organizations are subsequently calling for substantial changes in healthcare delivery to promote a more efficient, steadfast, and collaborative approach to care.2,3 As the family nurse practitioner (FNP) is often the first point of contact for these patients, it is essential the FNP is skilled at identifying at-risk individuals, providing comprehensive care, and developing strategies to encourage treatment adherence. This report will examine the prevalence and impact of T2DM, review risk factors, pathogenesis, and clinical presentation, and outline the most current evidence-based practice guidelines for adult and pediatric patients.