Diabetes Mellitus and Human Health Care: A Holistic Approach to Diagnosis and Treatment

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This accumulation of stressors and a failure of biologic resiliency, or allostatic load , may be defined as the Stage A—B transition. The intertwined multitude of stressors most individuals are exposed to in Stage A lead to complex phenotypes that eventually manifest as clinical and biologic signs.

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Traditional signs include elevated BP, dyslipidemia, and elevated blood glucose. We are proposing a paradigm shift in this mindset and recommend below-normal exercise performance and excess body mass be treated as signs of increased chronic disease risk and, when present, allow an individual to be classified as Stage B. Fig 1 lists examples of Stage B signs that hold significance. This list of signs is kept broadly defined and not intended to be exhaustive but rather an account of general themes as research into the optimal combination of signs for identifying risk will continue to evolve.

Moreover, depending on resources, health professionals may not be able to perform an exhaustive assessment of signs and, in such instances, should perform assessments using the means they have available. Early dysfunctions and chronic disease pre-cursors as signs of allostatic load are often overlooked in the traditional health care setting.

Individuals with the classic initial signs of chronic disease risk such as high BP, blood glucose and dyslipidemia as well as recently discovered signs such as telomere length shortening and changes in the gut microbiome usually do not go along with functional impairment in daily life. Moreover, diminished exercise performance is also usually undetected in the general population — a situation that could be significantly impacted going forward by integrating data from the growing set of digital health devices in the marketplace. This underperformance in exercise is partly due to the fact that a large percentage of the population, particularly those at greatest risk for one or more chronic diseases, leads a sedentary lifestyle, avoiding levels of exertion that would likely manifest an exertional Stage B sign e.

Complex dynamical systems, such as human beings, can have tipping points at which a sudden shift to a contrasting dynamical regime may occur.

Although predicting such critical points before they are reached is currently difficult, work in different scientific fields is now suggesting the existence of generic early-warning signals. Individuals in Stage B, if engaged, would benefit greatly from a pro-active, preventive approach with the goal of eliminating signs and returning an individual to Stage A. A variety of media may be used to ensure the patient understands the health information through text, visual aids, and verbal cues.

Since most individuals are either unaware of their downhill movement from health towards a chronic disease or unwilling to take steps to reverse this trajectory, they are unlikely to take preventive, proactive measures, such as lifestyle modifications or biological or pharmaceutical interventions. It is helpful to view this early health monitoring, psychoeducation, and counseling, as critical as early immunizations.

The knowledge and motivation can immunize young people from continuing down the silent path of chronic disease. In the absence of such, individuals continue to progress along the Stage B portion of the continuum; a cluster of signs both silent and those becoming increasingly apparent worsen in severity. After a variable time period, which may take decades, Stage B signs will give way to Stage C symptoms i. For example, dyspnea occurring within the range of exertional capacity needed for activities of daily living e.

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Persistent depression should also be viewed as a symptom that elevates chronic disease risk. Moreover, unhealthy lifestyle characteristics and abnormalities in key health measures are, in the vast majority of cases, also well established in Stage C and now compounded by outwardly apparent symptoms. In the traditional reactive healthcare system, the symptoms are oftentimes treated without addressing the poorly understood underlying causes and mechanisms that are at the root of the dysfunction, which are in large part unhealthy lifestyle behaviors. In this sense, this healthcare approach perpetuates the reactive cycle.

Symptoms become temporarily alleviated as the level of dysfunction persists and progressively worsens as do the unhealthy lifestyle behaviors, giving rise to subsequent symptomatic episodes and progressive biological damage. At this point, the risk for the eventual diagnosis of a chronic disease and transition to Stage D i. Once a chronic disease is diagnosed e. Treating a full blown chronic disease, such as coronary artery disease or cancer, requires expensive and often invasive interventions.

As in Stage C, underlying causes and mechanisms of the diagnosed chronic disease are not addressed.

Understanding Type 2 Diabetes

The reactive health care model is focused on stabilizing the individual in a hospital setting and ameliorating acutely elevated symptoms. Over the last several decades, we have become very efficient in this model as indicated by the decrease in annual CVD mortality rates. Even at this stage, environmental and lifestyle risk factors, which if modified substantially improve prognosis and quality of life,[ 91 ] are usually not addressed.


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As such, dysfunction continues to spiral downward and symptoms worsen with morbidity and premature mortality and increasing health care costs as the end result. While this does not have to be the case, once reaching Stage D, individuals commonly reside at this stage of health for the remainder of their lives, with a coexisting and compounding cluster of Stage B and C signs and symptoms, respectively.

What Makes For A Holistic Approach?

Moreover, many individuals are diagnosed with more than one chronic disease i. Health Stages A—D should not be viewed as unidirectional or stationary, progressing from apparent health to chronic disease with no hope of reversal. In this case, the individual who was diagnosed with a chronic disease i.

Viewing the stages of health in this manner allows individuals to understand the importance of improving health metrics and lifestyle behaviors irrespective of baseline health status. Both goals are equally important in the P4H continuum, ensuring appropriate care is given to individuals in all stages of health. Moving towards a modern, pro-active health care system, different levels of intervention must be clearly defined and the list of stakeholders invested in the implementation of the P4H continuum model must be expanded.

Health and well-being depend on a complex fabric of systems that are constantly interacting and shaping human biology, behavior and the environment, particularly with respect to lifestyle characteristics and chronic disease. The following sections describe the four intervention levels in the P4H continuum model, as illustrated in Fig 1. Global and country population strategies, otherwise defined as public health, strive to improve the health of a large population and reduce the chronic disease burden.


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The World Health Organization is the prime example of a global organization that has a strong focus in this area, as demonstrated by its initiatives, publications related to chronic disease and goals for improvement. Despite public health efforts and laws, health-changing behaviors are primarily shared across local communities and the environment within them. Despite being categorized as chronic NCDs, to a degree, follow a network pattern.

This has been shown with obesity and lifestyle-related chronic disease risk behaviors. Communities and social networks influence lifestyle patterns and behavior in a significant way. There are numerous examples on how to promote healthy lifestyle choices where individuals live, work, and attend school. Ultimately, the delivery of preventive medicine and healthy lifestyle interventions must reach and be embraced by a given individual — that is, it must be participatory.

Level III interventions are directed at the individual as a whole and thus healthy lifestyle interventions are a primary focus. To be effective in delivering Level III healthy lifestyle interventions, we must rethink the education of the health professions to ensure all disciplines receive the necessary education and training to effectively provide PA, weight loss, dietary or smoking cessation care plans.

This opens the opportunity for new career trajectories in the health care professions i. Healthy lifestyle is a universal medicine that should be provided by all health professions speaking a universal language. Level III interventions, delivered by a broad array of health professionals, must be expanded beyond the traditional walls of the healthcare system i. In particular, to optimally prevent chronic disease, there should be a strong focus on delivering Level III interventions in community settings; school systems, the workplace, public parks and libraries, grocery stores, pharmacies, in addition to traditional outpatient clinics and hospitals, are all appropriate settings for Level III interventions.

Level III interventions must also include the immediate family unit surrounding the individual receiving care. Adoption of and compliance with Level III interventions are optimized if those closest to a given individual become invested and believe in the care plan.

Levels I—III interventions focus on the whole individual, promoting participation in a healthy lifestyle. Level IV interventions are system-specific, targeting a specific physiologic system within an individual that demonstrates abnormal function or chronic disease.

Examples include: 1 pharmacologic interventions for hypertension, dyslipidemia or elevated blood glucose and 2 surgery for cancer or CVD. At this moment, Level IV interventions comprise the majority of care delivered in the current reactive healthcare system; most individuals currently receiving Level IV interventions are in Stage C and D health, receiving generalized care based on current scientific evidence. We are recognizing this generalized downstream i. Given the previously described where you have been — where you are now framework, all levels of intervention are essential to all health stages.

No matter what health stage an individual enters the P4H continuum model, the primary objective is to prevent future chronic disease diagnoses and adverse events, ameliorate symptoms and signs when present, and improve lifestyle behaviors. In this context, all intervention levels should be delivered at all stages of health.

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The right-side and lower panels of the P4H continuum illustrated in Fig 1 highlight stakeholders and overarching guiding principles for the model and are described in the following sections. Moreover, to make the impact needed in preventing and treating chronic disease, strong collaborations are required among stakeholders. These groups, formed within communities, should create innovative programming that is locally applicable and effective. Preventive medicine and healthy lifestyle interventions should not be a viewed as a one-size-fits-all approach.

The non-hierarchical multistakeholder model outlined in a U.

PreciDIAB - The holistic approach of personal diabetes care (EN)

Clearly the reactive health care model that currently exists is suboptimal, requiring a paradigm shift to improve global to individual health and address the current challenges we face with chronic disease and associated risk factors. We need a new approach, focusing on care that is preventive, predictive, personalized and participatory P4 as core principles of the P4H continuum model. Table 1 lists key factors to consider in delivering P4 medicine and subsequent sections describe key attributes. Predicting dysfunctions and detecting disease pre-cursors at Stage B allows for pro-active interventions to address the underlying mechanisms before symptoms occur.

Predictive medicine is essential to the preventive framework; when a risk factor phenotype manifests, predicting an increased likelihood for adverse events, all efforts should be taken to eliminate these risk factors, returning the individual to an optimal state of health. A biomarker is an indicator of a biological state, or the past or present existence of a particular type of organism. It is not necessarily a genomic or post-genomic one. Blood lipids are a risk factor for CVD.