Discussion Response

**This is due on 7/23/20 at 7:00 PM Central Time, not 7:00 AM as it appears on the order.

This is a response to a classmate's posting. It must be directed directly towards them, as if you were having a conversation with them. Please DO NOT critique their writing and/or grammar skills.

***Respond with a comment that asks for clarification, provides support for, or contributes additional information.

**Must contain at least one scholarly reference.

Here is what needs to be responded to:

The function of pharmacogenomics is to identify human genetic variants that involve an individual's reaction to a drug and how the drug is metabolized, absorbed, and distributed within the body (Mirsadeghi & Larijani, 2017). Type 2 diabetes mellitus is a complex illness that is one of the leading causes of morbidity and mortality (Dawed et al., 2016), also causing a range of long-term complications, such as renal failure, cardiovascular disease, retinopathy, and diabetic foot complications (Daniels et al., 2016). Type 2 diabetes mellitus is characterized by insulin resistance and is globally prevalent in almost a tenth of all adults (Daniels et al., 2016). The main focus of type 2 diabetes management is glycemic control (Zhou et al., 2016). There is a wide range of drug treatments for type 2 diabetes based on the mechanism of action. Sulfonylureas, Metformin, and meglitinide drugs are the primary oral hypoglycemic agents used to treat type 2 diabetes.  People with type 2 diabetes respond differently to drug treatments. For example, Metformin is poorly tolerated by up to 63% of individuals due to the gastrointestinal symptoms it can cause, resulting in a 5%-10% early discontinuation of the drug (Dawed et al., 2016). Pharmacogenomics recognizes genetic variants that can influence the effectiveness and toxicity of a drug (Mirsadeghi & Larijani, 2017). This helps provide personalized medicine to the patient in order to provide the best medical treatment. Individualized treatment regimens can increase drug efficacy, reduce side effects, and decrease costs (Daniels et al., 2016)   Nurses must recognize that each patient is a unique individual. Nurses must assess patient and family medical history as well as current lifestyle habits.  Identifying predisposing risk factors for patients can help nurses better educate the importance of healthy eating habits and active lifestyles. The incidence of type 2 diabetes may be delayed by maintaining a healthy lifestyle. Listening to a patient's concerns regarding medications and treatments is essential to provide a better treatment plan for their illness. For instance, if a patient is currently taking Metformin, and they inform the nurse of intolerable side effects, the nurse should advocate and consult with the physician for a new medication to replace it. If the nurse does not advocate for a new medication, then the patient will likely discontinue the use of Metformin, therefore leaving their type 2 diabetes untreated. Nurses should advocate for genetic resources and services, such as disease-specific support groups (Lebet et al., 2019). The National Human Genome Research Institute website (www.genome.gov) provides information for patients and families regarding genetic disorders and advancements in genomic research.

Nurses have an ethical obligation to make sure patients fully understand genetic testing and treatments available. Patients with limited health literacy may have an even harder time understanding genetics and genomics. Nurses must be informative and resourceful in order for the patient to make autonomous, informed healthcare decisions regarding genetic information (Tluczek et al., 2019). Genetic test results may include unintended findings and have health risk implications that could affect the patient's family members. Patients need to be informed of possible findings and how they will be addressed (Tluczek et al., 2019). Nurses should respect the patient's right not-to-know, which is included in a patient's right to self-determination (Tluczek et al., 2019). For example, a patient may choose whether or not to have genetic testing for a debilitating disease such as Huntington's because there is no curable treatment. Patients need to be informed of protective laws that prevent discrimination by the employer or health insurance provider based on genetic test results.

References

Daniels, M. A., Kan, C., Willmes, D. M., Ismail, K., Pistrosch, F., Hopkins, D., Mingrone, G., Bornstein, S. R., & Birkenfeld, A. L. (2016). Pharmacogenomics in type 2 diabetes: oral antidiabetic drugs. Pharmacogenomics Journal, 16(5), 399–410. https://doi-org.ezp.waldenulibrary.org/10.1038/tpj.2016.54

Dawed, A. Y., Zhou, K., & Pearson, E. R. (2016). Pharmacogenetics in type 2 diabetes: Influence on response to oral hypoglycemic agents. Pharmacogenomics and Personalized Medicine, 9, 17-29. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.2147/PGPM.S84854

Lebet, Ruth, PhD, MSN, Joseph, Paule, PhD, MS, RN, FNP-BC, Aroke, Edwin, et al. (2019). CE: Knowledge of Precision Medicine and Health Care: An Essential Nursing Competency. AJN, American Journal of Nursing, 119, 34-42. https://doi.org/10.1097/01.NAJ.0000586168.93088.3c

Mirsadeghi, S., & Larijani, B. (2017). Personalized medicine: Pharmacogenomics and drug development. Acta Medica Iranica, 55(3), 150-165. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F1876460046%3Faccountid%3D14872

Tluczek, A., Twal, M. E., Beamer, L. C., Burton, C. W., Darmofal, L., Kracun, M., … Turner, M. (2019). How American Nurses Association Code of Ethics informs genetic/genomic nursing. Nursing Ethics, 26(5), 1505–1517. https://doi.org/10.1177/0969733018767248

Zhou, K., Pedersen, H. K., Dawed, A. Y., & Pearson, E. R. (2016). Pharmacogenomics in diabetes mellitus: insights into drug action and drug discovery. Nature Reviews Endocrinology, 12(6), 337–346. https://doi-org.ezp.waldenulibrary.org/10.1038/nrendo.2016.51