There are indeed reasons for such things happening to him, and there are both physical and social factors for such poor results that if continued will have long-term implications on his health conditions, and this case study intends to analyze all those factors involved in his case to formulate a management plan customized for him (Adler, AI, 2003).
As in the case of John, prolonged exposure to hyperglycemia is recognized as the primary causal factor in the pathogenesis of complications associated with diabetes mellitus. Hyperglycaemia and poor control of blood sugars in his case would induce a large number of alterations in the vascular tissue that would promote accelerated atherosclerotic process consequentially. These effects are often irreversible and they lead to progressive endothelial cell dysfunction. Once established, they progress over time, and reversal of hyperglycemia to normoglycaemic ranges would not reverse the pathology back to normal. Moreover, in his case associated overweight, dyslipidaemia, and hypertension, all independently promote atherosclerosis that is known to be a single most important pathological event to precipitate a cardiovascular accident, the prognosis of which becomes far less encouraging in the backdrop of his family history of and his diabetic disease (Blendea MC, McFarlane SI, Isenovic ER, Gick G, Sowers JR., 2003).
One of the important mechanisms responsible for the accelerated atherosclerosis in diabetes is the nonenzymatic reaction between glucose and proteins or lipoproteins in arterial walls. Glucose forms chemically reversible early glycosylation products with reactive amino groups of proteins. Diabetes mellitus (DM) increases coronary heart disease (CHD) mortality. Reduction of serum cholesterol levels, arterial pressure control, quitting smoking, weight control, diabetes improvement, and physical activity (Frayn KN., 2001) improve the endothelium-dependent response. Both type 1 and type 2 diabetic patients have mostly been described under enhanced oxidative stress, and both conditions are known to be powerful and independent risk factors for coronary heart disease, stroke, and peripheral arterial disease. Coronary artery disease and glucose metabolism alterations in diabetes mellitus have raised to the idea that atherosclerosis and diabetes may share common antecedents. In his case, with his development of diabetes with a genetic background and probable environmental antecedents, there is a higher chance of complications that would need interventions to prevent calamities (Bloomgarden, ZT., 2005).
John's problem is not isolated. Diabetes, both type 1 and type 2, is increasing in prevalence and it is estimated that three million individuals in the UK will have type 2 disease by 2010. John is middle aged overweight male, and as predictable, this would have a concomitant risk factor for cardiovascular disease. It is worrying in his case since type 2 diabetes mellitus increases the risk of all