What I want to do and why (Thesis)

Diabetic Nephropathy is the most common cause of chronic kidney failure and end stage kidney disease in the United States. Patients in the final stages of end stage kidney disease either have the option of dialysis or kidney replacement, and there is not enough knowledge or awareness about what patients can do once having this disease, or what can one do to prevent this disease. This happened to my grandma who unfortunately passed away in 2007, she did not speak English well and because of this she was not well informed about her disease or on how to control it and prevent it from progressing to kidney disease until it was too late. She had to suffer through many years of dialysis because she could not find a kidney donor, until she passed away. She is the main reason as to why I chose this project because I want to be able to provide information and awareness to those like my grandma who were not well informed and did not know anything about her disease.

One possible solution to this problem is to give out information to the public by having health fairs specifically about this disease to those that have not been diagnosed, and provide more information to those who have. Another way to help diagnose patients is by showing them what nutrition lifestyle they should be following. Also to see what stops patients from fulfilling things that have to be done to keep them healthy and what could be stopping them from fulfilling them. Such as cultural barriers, nutritional changes, or motivation, and how we can increase patient compliance to prevent kidney failure. For those patients in the final stages of end stage kidney disease that have the option of dialysis or kidney replacement, and have many obstacles that prevent the them from complying, we need to know what is stopping patients from fulfilling things that have to be done to keep them healthy and what could possibly be these barriers. Examples of barriers could be cultural barriers, motivation, financial problems, or nutritional changes, and other physical barriers. Finding out what patients can do once having this disease, or what can one do to prevent this disease while facing these barriers is very important to know. Being aware about this disease whether it being from already having it or before being diagnoses is very important, and there are many websites and programs available, but there is not enough awareness or knowledge about those programs.

In a study of cost-effectiveness of angiotensin-converting-enzyme (ACE) inhibitors, William F. Clark and some of his colleagues based their results of a patient interview study which 34% of patients said that cost is their primary barrier to compliance. Culture is another barrier, for example many Native American tribes, such as Ojibwa, Cree, Dakota, and Navajo tribes, believe that this is a new disease introduced by the “white man.”,  because diabetes is believed to come from imbalance and caused by eating too much sugar, and food in general, consuming alcohol, or acting immorally. Being diagnosed with diabetes may show that one is a failure at living properly and lacking spiritual strength, which can lead to one feeling ashamed by the diagnosis and will refuse telling others. Certain foods, herbs, folk or traditional therapies may be other barriers, because they may prevent one from seeing a doctor and receiving treatment. Other barriers may be religion and prayers, which many Latinos, and African- Americans will turn to for help or believe that this disease is a punishment by God. Depression can be a mental barrier by decreasing the patient’s ability to accomplish tasks or their ability to concentrate. According to Patrick J. Lustman, PhD and Jeffrey A. Gavard PhD, psychological and Physiological aspects of this disease would be depression as well as anxiety disorders. Stress would also be both a physiologic and psychological aspects contributing to the diabetic symptoms. These disorders can affect emotional, physiologic and psychological aspects, by being depressed and anxious, also by causing the patients to take medications to help with the disorders, and not allowing the patients to do certain things because of the disorders.

Some examples of existing organizations that are already working on helping patients with diabetes and on developing more research are American Association of Diabetes Educators which has specialists that have interest and training in diabetes care. American Diabetes Association (ADA) is a national organization focuses on research for the prevention and treatment of all types of diabetes. National Diabetes Education Program (NDEP), sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC), have a common goal to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes.

            A possible solution to this problem is to give out information to the public by having health fairs specifically about this disease to those that have not been diagnosed, and provide more information to those who have. A way to finance these health fairs are for organizations that are already helping the community, help by sponsoring these events. They could also possibly help by speaking at these events and having different workshops that focus on specific aspects of diabetic nephropathy. Another way to help diagnosed patients is by showing them what nutrition lifestyle they should be following such as keeping cholesterol levels under control, a low-fat diet, regular exercise, consulting a renal dietitian, limiting protein and sodium intake. Also learning how to overcome different types of barriers such as cultural barriers, nutritional changes, or motivation, and how we can increase patient compliance to prevent kidney failure.

            Having informational health fairs would be very beneficial, especially if they were to be sponsored by one of organizations and agencies that specialize in diabetes because the specialists would be able to give in-depth details about the disease. Also they could possibly even take blood tests to determine if the patients are diabetic. Providing information about the diets and nutritional lifestyle changes that the patients should have would help them live a healthier lifestyle and keep their diabetes under control. This information could be posted and available at local pharmacies, hospitals, healthcare fairs, and any other location where it would seem reasonable to post this type of information. Once knowing what some of the barrier to patient compliance is we could find out ways to solve them or work around them. For example if it’s a physical barrier such a not having a method of transportation, it can be solved by having medical vans that transport patients to either their doctor appointments, medication pick-ups, therapy for a transplant, or dialysis if they are in their final stages of kidney failure. To help with mental/ psychological barriers, more support groups could be made locally so that it would be easier for patients to attend, and loans could be made for patients that are having trouble paying for medication or treatments, or plans could be made to raise money for patients in need, as well as donations.