A Study Of The Fulfilment Of Last Mile Delivery In Food Delivery Service Sample Assignment


Last mile delivery is the last stage goods go through before they reach the consumer. Despite being a great determinant to consumer contentment, last mile delivery is expensive and a tedious phase of product distribution. Last-mile delivery in the food sector experienced more changes when the COVID-19 pandemic struck. Before COVID-19 struck customers were used to the convenience of digitization. The pandemic intensified this granted safety dominance. Despite this last mile delivery still faces numerous logistical issue. Nonetheless, these challenges can be overcome by optimizing the last mile delivery to reduce the general transport costs. Companies can also assess the following indicators to manage these challenges exhaustively; contactless food distribution, impacts of third parties in the last mile, and increased perishability. HK delivery companies can pool these indicators with digitization to create a sustainable last-mile delivery system


1.1 Background information

Last-mile delivery is the last phase of the shipping process that goods go through before getting to the consumer. Last-mile delivery is a significant determinant of consumer contentment. It’s usually expensive and a tedious part of the product shipment process. Persons who have tracked shipments online understand the uncertainty and pressure that last-mile creates. At this shipment stage, the process encompasses multiple stopovers with product drops. For example, the drop of points in a rural area could be miles apart. A similar situation can be replicated in an urban area when traffic congestion quashes drop-off points. The expansion of e-commerce has made challenges associated with last-mile delivery more complex due to the rise in retail sales. The rise in retail sales has led to a corresponding rise in the number of parcels distributed daily, altering consumer anticipations to include fast and free delivery.

The expenditure spent on last-mile delivery accounts for 53% of the entire shipping budget. Since delivery is increasingly becoming free, consumers are reluctant to foot this bill, leaving it a responsibility to retailers and logistical colleagues. Therefore last-mile delivery is an area that companies are keen on and are willing to change.

1.2 Objectives of the Study

  • To critically assess the significance and influence of delivery and fulfilment in food delivery service.
  • To detect the delivery and fulfillment concerns faced by Hong Kong food delivery firms.
  • To extensively and intensively evaluate the efficiency of present logistics models for delivery and fulfillment.
  • To determine ways of meeting consumer needs comprehensively in the food and beverage sector.

Literature Review

Initial delivery model

Initial delivery model

According to Iwan et al. (2016), before last-mile delivery, transport of the food industry consisted of the; kitchen, marketplace, feedback, and logistics. These components collaborated to meet consumer needs and enhance profitability. Therefore providers focused on assessing these components to generate profits and preserve the business’s name. Businesses interacted with their clients via white-label channels. Saguna et al. (2021) argues that gradual technological advancements ushered most of these clients into e-commerce forcing providers to turn to last-mile delivery for competitive advantage. Organizations started creating and testing various supply chain models to amplify parcel capacity and meet consumer needs. Unfortunately, last-mile delivery for all these models continues to face numerous issues.

Importance of last-mile delivery

In 2018, e-commerce experienced explosive growth in sales, creating competition among retailers in the contest to reach consumers. Sellers are under pressure to fulfill their obligations within a reasonable duration. Getting last-mile delivery right remains the solution to this pressure. Previously, brick and mortar were the order of the day; online purchases were still available, although shipping took almost two months (Orjuela, 2019). Presently customers expect their deliveries at least the same day after request. As technology advances, the demand for e-commerce sales is also rising, and sellers have to develop mechanisms to cope with this demand. The retail sector is changing rapidly, and traders are improving their last-mile solutions to remain competitive. For instance, in 2018, Amazon dominated the American retail market due to its prime next-day and same-day distribution service. As more customers turn to e-commerce for their purchase needs, fast delivery will be a competitive point and an expectation from all online shoppers.

Hence if sellers and their logistic associates seek to gain a significant market share, they ought to prioritize last-mile delivery. Contemporary sellers need last-mile solutions that can make deliveries within two hours. Last-mile stores enhance the movement of products within the last phase of the supply chain based on the studies by Zhou et al. (2020). Therefore being closer to the consumer reduces the time and cost required for last-mile delivery. Consequently, the time taken to deliver a package from a last-mile store to the consumer is more important than its actual mileage. The traffic situation in urban areas also determines the chances for success in last-mile delivery. Hence profound understanding of the transportation system is needed to determine a last-mile location (Iwan et al 2016). Sellers should strive to have high-quality logistic services which can allow them to serve consumers with different profiles.

As providers strive to meet the growing demand for fast delivery, consumer expectations increase while their experiences are declining. Even though fast delivery is essential, consumers have suffered a lack of accuracy and professionalism during delivery. Hence the firms seeking to gain consumer loyalty can tap into this opportunity, consumers seeking quality and professionalism (Iwan et al. 2016). Increased demand for same-day deliveries has also compounded the effectiveness and reliability of last-mile delivery. F&B companies located near big cities need to invest in the following features to ensure that last mile deliveries are successful:

The correct positioning. Last-mile facilities near major roads and bridges can deliver to more consumers than those on a city’s outskirts. These facilities can be more advantageous in cities where boroughs are interconnected and within close proximities (Saguna et al. 2021).

Perfect building quality. Majority of logistics departments in other sectors are located in ancient buildings. These buildings often have limited structural and electrical capacities. The structures were designed to suit business needs in the past and can barely support the load of goods shipped today. Since last-mile delivery in the F&B sector is a relatively new venture, providers should learn from other industries and select buildings that can suit current business needs (Kiba et al. 2021). For instance, a building with reasonable ceiling heights can allow the storage of vertical racking systems. With an appropriate speed bay, these racks enhance the flow of goods.

Cross-dock potential. By optimizing this, potential F&B providers can tackle one of the significant issues facing the last-mile facilities in this industry. The researches of Zhang& Lee, (2016) denotes cross-docking as receiving products via one door and then shipping them out almost immediately via another door. This practice allows for the adequate transportation of perishable goods by eliminating storage and preservation. With an influential loading dock ratio, consumers can load F&B on every dock without using an elevator. A floor capacity of up to 800 pounds can meet all the food and beverage sector needs.

Prospective planning. Since technology is rapidly evolving, last-mile facilities need to have elements such as electric charging stations, which shall be of importance in the future. The last mile also accounts for 30% of the delivery cost and is mainly dependent on gas and labor; providing an eco-friendly option can make F&B facilities more competitive (Shaheen et al. 2020).

Technology solutions to better last-mile delivery

The rise of the gig economy has allowed many consumers to access crowdsourcing facilities through applications such as Uber. Many establishments have turned to location-based crowdsourcing that allows customers to use their services via mobile applications according to Puram et al. (2021). This model has also been adopted in the food and beverage sector. Providers prefer to use this model since it requires little capital to start and offers customers memorable shopping experiences. Crowdsource technology pools all stakeholders, thereby enhancing their interaction (Orjuela, 2019). For instance, a consumer can interact with domestic couriers to facilitate parcel delivery through this platform. Consequently, organizations can use this technology to deliver goods faster at the desired time.

Last-mile backdrop in the food and beverage industry

The last-mile delivery model is extensively advanced in the food industry. This model has witnessed tremendous evolution in this industry in the last decade. The onset of coronavirus turned this transformation into rapid growth to cater to the rise in consumer needs. Before the pandemic, consumers were used to enjoying the convenience of digitization (Saguna et al. 2021). Nonetheless, this debate shifted from convenience to safety when the pandemic struck. Therefore providers focused more on safety other than just delivering goods. This led to an increase in the need for fresh products, which is likely to persist even after the pandemic due to changes in customer primacies, including;

  • The transformation from delivery for suitability to emphasis on safety
  • Increased comfort and willingness to have essential commodities distributed.

The performance of this model may vary across different geographies. Hence providers in the F&B industry need to continue investing in after-sales experience.

Significant trends in the F&B last-mile setting

At the pandemic’s peak, last-mile providers in the food sector focused on meeting the service demand. Since the pandemic has subsided, the last mile is likely to experience tremendous growth, creating more opportunities. Nonetheless, the opportunities also present challenges such as stiff competition, which may trigger rapid evolution in the industry (Lin et al. 2022).

Changing expansion primacies. Currently, hybrid models are the most favored approaches to expansion. Food providers vary their takeout and delivery channels to cope with changes in demand. Some hybrid models in use include ordering online and collecting in-store, delivery to the consumer, and subscription model (Altenried, 2019).

Assuring safety. After the pandemic safety of the foods delivered has become more paramount. A survey by Deloitte shows that after the pandemic, a particular portion of people is still unwilling to visit the store (Lin et al. 2022). Hence safe deliveries are a priority for providers who intend to capture this market share.

Renewing customer trust through a lasting customer experienceAs establishments seek to generate a lasting home experience for clients, consumer experience will be a crucial determinant for success among food providers.

Increasing food delivery. During the pandemic, businesses with the established delivery system had an advantage making their competitors appreciate the importance of this add-on service (Srinivas& Marathe, 2021). Firms without an in-house delivery provider had to rely on third-party providers, thereby driving inter-sector partnerships. Customers choose the F&B providers who can get goods to them safely and quickly with flexibility.

Changing consumer behavior. A report by Deloitte shows that at the peak of the pandemic, customers were willing to pay high premiums for safe and fast delivery. Nonetheless, with the easing of lockdowns and other COVID restriction measures, consumers opt for cost-efficient approaches such as self-pickup from convenient points (Saguna et al. 2021).

Similar to other locations, the last mile environment in Hong Kong appears to be reasonably mature and growing in a direction that is innovative and full of opportunities. New ideas such as the adoption of cloud kitchens or autonomous deliveries may be essential drivers in the future (Lin et al. 2021). While these innovations are slowly being adopted in the F&B sector, full adoption of these technologies will better consumer standards by enhancing flexibility and safety.

Last-mile delivery role in HK food sector.

Last-mile delivery was a bonus, but presently it’s a must-have for all businesses, primarily in the food industry. The coronavirus pandemic changed the last mile logistics in the food industry by making customers eager to pay a premium for last-mile services. The pandemic containment measures forced businesses to turn to doorstep delivery to remain competitive. This adjustment paused an imminent threat to the food industry. No matter their size, all restaurants had to develop a delivery system of their own to remain in the market.

Despite the food delivery system being in place, several logistical challenges still exist in the food industry. One of these is the worry of keeping up with consumer expectations. Many consumers have access to food delivery apps; they expect providers to deliver fast and efficiently (Lin et al. 2022). Nonetheless, this is a hurdle that many providers are yet to overcome. Additionally, the potentially missed deliveries is a big challenge. Missing a delivery is possibly one of the significant risks in the food industry. With orders consistently coming in, it can be challenging to determine the pending orders and those already delivered. The constant flow of orders also increases the chances for human error when multiple restaurants are yet to install digital systems to manage this data.

Also, the inefficient management could cost the business dearly. Many restaurants are yet to adapt fully to the delivery system. Hence their employees lack the skills to manage orders efficiently, thereby creating risks in the food industry (Lin et al. 2022). Poor management leads to delays in deliveries and is also a quality compromising factor. Any restaurant associated with poor management is likely to lose potential clients. Last is the challenge of tracking orders as outlined by Viljoen et al. (2014) in their study? Tracking is an essential part of the food delivery system. Consumers want to track their orders in real-time to determine when they will arrive exactly. Nonetheless, this is a consumer need that restaurants are yet to meet.

Discussion and Management Implications

Over the last ten years, the last-mile delivery has undergone significant changes on the back of technological applications. The F&B industry has adopted these technologies to enhance service delivery. The pandemic pushed people to new ways of managing food by altering consumer behavior and ushering more people into e-commerce. In a study conducted by Deloitte in 2020, most respondents reported ordering food via delivery services. Nearly half of the respondents stated that they would stick to these habits even after the pandemic (Puram et al. 2021). Apart from takeout and delivery options, consumers also turned to cashless payment and end-to-end transparency of their orders. During the pandemic, transparency updates also captured the health status of delivery personnel as a precautionary measure. Consumers also desire to have a flexible shopping experience where they can edit shopping lists at will (Altenried, 2019). Any brand that meets all these needs stands a chance of creating a loyal customer base.

Following a change in the market scenario and consumer behavior, it’s safe to say that the global online food industry is on a growth trajectory. Estimates show that this market could reach $192.16 billion by 2025 from $126.91 billion in 2020. Like other locations in the world, HK’s food delivery industry faces an array of challenges down the entire supply chain (Lin et al. 2022). These challenges make the implementation of this system more expensive. Nonetheless, these challenges can be overcome by optimizing the last mile delivery to reduce the general transport costs. In addition to this, the following indicators can be further looked into to overcome these issues.

Impacts of third-party providers on the last mile

Presently, most HK consumers are willing to pay extra money for faster deliveries. Restaurants and food delivery companies in HK can hardly keep up with consumer needs; therefore, they turn to third-party providers for delivery services. The introduction of third parties often compounds the existing challenges due to disorganized routine practices, which creates the inability to estimate turnaround time (Naumov& Pawlus, 2021). The breakdown caused by third parties during last-mile delivery jeopardizes the entire shipping process and shrinks the profit margins. This challenge can be overcome by adopting a comprehensive network model which covers the entire supply chain. Alternatively, these entities can create an internal delivery system that supports the present and future business expansions.

Increased perishability

During the COVID-19 pandemic, delivery companies were extra cautious about safety to avoid contamination. As a result, a portion of the public earned trust in the food delivery systems, which has led to an increase in demand for foodstuffs and other fresh items. To guarantee the safety of fresh products, delivery companies have adopted technologies that can monitor operations at a cost (Castillo et al. 2018). These technologies allow companies to cope with increased demand using crowdsourcing, transforming every shopping experience. The technologies offer distribution companies automated allocations, constant tracking, and route optimization. These processes make the delivery process easy and reduce the risk of spoiling fresh products.

Contactless food distribution

During the pandemic, some delivery companies adopted contactless deliveries to cater to the needs of people in isolation. They could distribute food using robots and drones. Out of these approaches, drones received the most excellent attention. Moving forward, food distribution companies can adopt this technology, although it necessitates that the firms should be financially stable (Osakwe et al. 2022). They should also observe all the government regulations before using this technology entirely.

Enhancing last-mile delivery to beat rivals

Rivalry in the food delivery sector has increased rapidly, especially after COVID-19. Therefore F&B companies in HK are keen to better their last-mile delivery. These firms need to use end-to-end technologies with features like constant tracking, fleet monitoring, dispatch organization, and analytics to excel in this field (Viljoen et al. 2014). With this technology, administrators can constantly monitor the delivery representatives. The end-to-end toolkit recommends the best route to the delivery personnel and notifies their superiors immediately when unnecessary stoppages and diversions are made (Lin et al. 2022). The system also optimizes delivery routes concerning traffic and weather updates and the delivery’s urgency, thereby keeping drivers informed all the time.

On the other hand, the automatic dispatch system plans the routes and allocates the tasks to drivers based on their location. It optimizes the available drivers and prevents disorganization, which can otherwise result from human error. It simplifies the delivery process and aids in reducing final mile delivery costs. Likewise, these agencies can also adopt a proof of delivery to ensure the entire process remains transparent (Altenried, 2019). Proof of delivery is a document with the recipient’s signature and other details which affirm that an order has been delivered. This document is pooled with a mobile application that allows the driver to collect a recipient’s details.

Delivery companies can also monitor the crucial business indicators to assess their performance in the market. These indicators include consumer ratings, the performance of delivery personnel, and the number of incomplete deliveries (Saguna et al. 2021).

As food delivery firms in HK continue to compete firmly, concentrating on consumer experience will be the key to success. These companies ought to have a simple and transparent system with open communication channels. Allowing consumers to send real-time feedback is a great strategy that strengthens the distribution channel. To create a loyal consumer base, these companies can also conduct periodic surveys to collect consumer feedback, after which the firm should resolve these complaints (Zhou et al. 2020).


Last-mile delivery is yet to reach maturity; therefore, food delivery companies in HK have opportunities that they can exploit to ignite growth. These opportunities include:

  • Invest in digital technology such as delivery bots and drones.
  • Build warehouses around HK to enhance the faster delivery of products.
  • Invest in intelligent tracking technologies to keep consumers informed about delivery status.
  • Deliver orders as soon as possible after request.
  • Delivery drivers can also work as sales representatives to boost company sales.
  • Companies can embrace electric cars since consumers are aware of environmental issues. This would make the last mile carbon delivery eco-friendly.


Over the last decade, the last-mile delivery has undergone momentous transformation. The food and beverage industries have been the greatest beneficiaries of this transformation. Last-mile delivery in the food sector experienced more changes when the COVID-19 pandemic struck. Before the pandemic struck customers were used to digitization and convenience. The pandemic augmented this leaning and improved the focus on safety via distribution. The most recent last-mile advancements in the F&B sector circle around digital customer engagement, automation, and Industrial Corporation. Even after the pandemic, the delivery of fresh and cooked foods is likely to increase due to two main changes in consumer behavior. One is the shift from delivery for convenience to the focus on safety. Second is enhanced comfort level and the preparedness to deliver basic needs. Despite being an essential fragment of the distribution procedure, the last mile delivery process faces several logistical challenges. One is the constant pressure to meet consumer needs. Second is the probability of missed deliveries due to human error or increased workload. Last is inefficient management since most restaurants are not fully digitized.

Nonetheless, these challenges can be overcome by optimizing the last mile delivery to reduce the general transport costs. Companies can also assess the following indicators to manage these challenges exhaustively; contactless food distribution, impacts of third parties in the last mile, and increased perishability. HK delivery companies can pool these indicators with digitization to create a sustainable last-mile delivery system.


Altenried, M. (2019). On the last mile: logistical urbanism and the transformation of labour. Work Organisation, Labour & Globalisation13(1), 114-129.

Cardenas, I., Borbon-Galvez, Y., Verlinden, T., Van de Voorde, E., Vanelslander, T., & Dewulf, W. (2017). City logistics, urban goods distribution and last mile delivery and collection. Competition and regulation in network industries18(1-2), 22-43.

Castillo, V. E., Bell, J. E., Rose, W. J., & Rodrigues, A. M. (2018). Crowdsourcing last mile delivery: strategic implications and future research directions. Journal of Business Logistics39(1), 7-25.

Galkin, A., Obolentseva, L., Balandina, I., Kush, E., Karpenko, V., & Bajdor, P. (2019). Last-mile delivery for consumer driven logistics. Transportation Research Procedia39, 74-83.

Holdorf, S., & Haasis, H. D. (2014, December). Last mile delivery concepts in E-Commerce an empirical approach. In The 8th International Conference on Software, Knowledge, Information Management and Applications (SKIMA 2014) (pp. 1-6). IEEE.

Iwan, S., Kijewska, K., & Lemke, J. (2016). Analysis of parcel lockers’ efficiency as the last mile delivery solution–the results of the research in Poland. Transportation Research Procedia12, 644-655.

Janjevic, M., & Winkenbach, M. (2020). Characterizing urban last-mile distribution strategies in mature and emerging e-commerce markets. Transportation Research Part A: Policy and Practice133, 164-196.

Kiba-Janiak, M., Marcinkowski, J., Jagoda, A., & Skowrońska, A. (2021). Sustainable last mile delivery on e-commerce market in cities from the perspective of various stakeholders. Literature review. Sustainable Cities and Society71, 102984.

Lin, Y., Marjerison, R. K., Choi, J., & Chae, C. (2022). Supply Chain Sustainability during COVID-19: Last Mile Food Delivery in China. Sustainability14(3), 1484.

Macioszek, E. (2017, September). First and last mile delivery–problems and issues. In Scientific and technical conference transport systems theory and practice (pp. 147-154). Springer, Cham.

Naumov, V., & Pawluś, M. (2021). Identifying the optimal packing and routing to improve last-mile delivery using cargo bicycles. Energies14(14), 4132.

Orjuela-Castro, J. A., Orejuela-Cabrera, J. P., & Adarme-Jaimes, W. (2019). Last mile logistics in mega-cities for perishable fruits. Journal of Industrial Engineering and Management12(2), 318-327.

Osakwe, C. N., Hudik, M., Říha, D., Stros, M., & Ramayah, T. (2022). Critical factors characterizing consumers’ intentions to use drones for last-mile delivery: Does delivery risk matter?. Journal of Retailing and Consumer Services65, 102865.

Puram, P., Gurumurthy, A., Narmetta, M., & Mor, R. S. (2021). Last-mile challenges in on-demand food delivery during COVID-19: understanding the riders’ perspective using a grounded theory approach. The International Journal of Logistics Management.

Shaheen, S., Cohen, A., Chan, N., & Bansal, A. (2020). Sharing strategies: carsharing, shared micromobility (bikesharing and scooter sharing), transportation network companies, microtransit, and other innovative mobility modes. In Transportation, land use, and environmental planning (pp. 237-262). Elsevier.

Srinivas, S. S., & Marathe, R. R. (2021). Moving towards “mobile warehouse”: Last-mile logistics during COVID-19 and beyond. Transportation Research Interdisciplinary Perspectives10, 100339.

Suguna, M., Shah, B., Raj, S. K., & Suresh, M. (2021). A study on the influential factors of the last mile delivery projects during Covid-19 era. Operations Management Research, 1-14.

Tsai, Y. T., & Tiwasing, P. (2021). Customers’ intention to adopt smart lockers in last-mile delivery service: A multi-theory perspective. Journal of Retailing and Consumer Services61, 102514.

Viljoen, A., Kruger, S., & Saayman, M. (2014). Understanding the role that Quality of Work Life of food and beverage employees plays in perceived service delivery and productivity. Southern African business review18(1), 27-52.

Zhang, S. Z., & Lee, C. K. M. (2016, December). Flexible vehicle scheduling for urban last mile logistics: The emerging technology of shared reception box. In 2016 IEEE International Conference on Industrial Engineering and Engineering Management (IEEM) (pp. 1913-1917). IEEE.

Zhou, M., Zhao, L., Kong, N., Campy, K. S., Xu, G., Zhu, G., … & Wang, S. (2020). Understanding consumers’ behavior to adopt self-service parcel services for last-mile delivery. Journal of Retailing and Consumer Services52, 101911.

Appendix 1.

Working timeline

Item Duration
First meeting 11 Feb 2022
Proposal 18 Feb 2022
Second meeting 04 Mar 2022
Third meeting 18 Mar 2022
Progress Report 25 Mar 2022
Fourth meeting 08 Apr 2022
Last meeting 22 Apr 2022
Final report 29 Apr 2022

A Global Health Perspective In Fighting Diabetes Essay Example


The worldwide epidemic of type-2 diabetes jeopardizes the health and economics of every nation, but especially those in poorer countries. According to the WHO, nutritional changes, increased urbanization, and an increase in sedentary lifestyles all contribute to this pandemic. Obesity is a major contributor to the worldwide pandemic of diabetes, which has reached epidemic proportions. As a result, people’s eating patterns have shifted, resulting in an increase in caloric intake, which is a risk factor for type 2 diabetes. Additionally, enormous quantities of sugar-sweetened drinks are consumed, contributing to an individual’s total weight increase and raising their chance of acquiring type 2 diabetes. Since global trade liberalization increased the availability and affordability of food commodities such as sugar and edible oils, they have become more affordable and accessible to a broader number of people. Globalization of dietary trends has been attributed to an increase in animal fat consumption, an increase in fast food consumption, and a decrease in fiber consumption, among other factors.

China has the biggest population of diabetics (114 million) in a single nation, with the majority of them having type 2 diabetes. This is a big challenge for China’s authorities, who have dramatically expanded the number of people covered by health insurance over the previous decade. In China, the medical care of diabetes, excluding complications, is expected to spend 8.5 percent of the country’s total health expenditure (Xue et al., 2020). Their Clinical Implications in Personalized Medicine T2D is diagnosed in Chinese patients at a younger age and with a lower BMI than in European patients. T2D is more common in Chinese patients than in European patients (Hu C, 2018) Diabetes prevalence was less than 1 percent in 1980 (2), 5.5 percent in 2001, 9.7 percent in 2008, and 10.9 percent in 2013. Diabetes prevalence has increased steadily since 1980. As reported by the American Diabetes Association’s 2010 criteria, which were 0.5 percent higher than the World Health Organization’s 1997 criteria, which did not include a HbA1c level of less than 6.5 percent as a diagnostic criterion for diabetes, 4.5% of adults had previously been diagnosed with diabetes, with 6.9% of adults being diagnosed for the first time based on these 2010 criteria. Obesity, ageing, and eating habits are all influenced by environmental variables such as nutrition. Stagnant lifestyles, increased intake of processed foods and fats, hereditary variables and epigenetic alterations are all factors that lead to the development of diseases (Weker, 2006).

The increasing diabetes pandemic in China has been related to the population’s increased risk of developing diabetes. A relationship has been shown between hypertriglyceridemia, one of the most common types of dyslipidemia, and a higher risk of type 2 diabetes (Yuan et al., 2007). Additionally, nonalcoholic fatty liver disease, which is a significant predictor of type 2 diabetes, affects around 15 percent of China’s general population, according to official figures. An examination of 20 studies found that non-alcoholic fatty liver disease substantially elevated the risk of incident type 2 diabetes and metabolic syndrome during a 5-year follow-up period, according to the findings of a new meta-analysis (Mantovani, 2018). T2D, on the other hand, has a bidirectional link with metabolic illnesses, since it strongly predicts the start of metabolic disorders. Compared to the general population, diabetes patients had a 3.6-fold greater risk of cardiovascular disease, according to the China National Diabetes and Metabolic Disorders Study conducted in 2007 and 2008. Diabetes type 2 affects people all across the world, not only in China. A reduction in the consumption of roots and pulses has been seen in the majority of nations.

Chinese authorities have set a long-term goal of eradicating diabetes in the country (Tabish, 2007). This objective is part of the Chinese government’s Healthy China 2030 initiative, which aims to cure all chronic diseases throughout the duration of a person’s life (Ginsberg, 1994). When it comes to digital health solutions, China has risen to become the world’s leading innovator. Taking advantage of their success in areas such as mobile payments, Chinese internet businesses are rushing to reshape the country’s overcrowded healthcare system. Technology is being used to improve healthcare access in rural locations. One-minute clinics, such as those found in picture booths, and smart ambulances equipped with artificial intelligence are two examples of how technology is being used to improve healthcare access in remote areas.

Type 2 diabetics are more prone than other diabetics to suffer heart disease, stroke, and other serious complications. According to the World Health Organization, 382 million individuals globally have the condition, however only 175 million of those cases were diagnosed in 2013. These incidents were more prevalent in low- and middle-income nations than in higher-income ones, according to the findings. In recent years, worldwide incidence of type 2 diabetes has increased dramatically, and this trend is projected to continue.

Over the next 20–40 years, it is projected that the present pace of growth will be maintained. Several factors, including a shift in the epidemiological landscape in which communicable diseases have fallen out of the top 10 causes of death, as well as an accompanying nutritional shift characterized by increasingly unhealthy eating patterns and lower levels of physical activity, have been proposed as major contributors to the rapid increase in diabetes worldwide at the population level:

Diabetes-related disease patterns are evolving at a high speed. Nowadays, people suffering from Type 2 diabetes can now be found in almost every nation on the world. It was formerly assumed to be a sickness that only affected the wealthy, but it is increasingly growing more prevalent among the working class. Since childhood obesity was formerly almost unheard of in children, it has grown increasingly prevalent among specific ethnic groups of youngsters, particularly in the United States.

Diabetic complications were predicted to account for 12 percent of global health expenditures in 2010, amounting to $376 billion, with this number estimated to climb to $490 billion by 2030. Sun and colleagues, 2021 the increasing incidence of HIV/AIDS, as well as the health difficulties that accompany it, endangers the economic benefits that emerging nations enjoy. Because of a lack of diabetes-care infrastructure in many nations, many people are unprepared to cope with the pandemic. The year 2018 is a year of transition (Ide, 2018). Asia is home to 60 percent of the world’s diabetics, according to the International Diabetes Federation. Asian economies have had rapid growth in recent decades, cities have grown densely inhabited, and food supplies have undergone significant transformation.

A variety of variables have been identified as contributing to the worldwide prevalence of type 2 diabetes, according to the research. Obesity and excess weight are two of the most important contributing factors to the worldwide diabetes pandemic. Adults in the wealthiest countries are impacted, and their incidence is rapidly increasing in the poorest countries. The incidence of overweight and obesity in Asian countries is lower than in Western countries, despite an increase that has coincided with economic development and fast urbanization.

Another factor that contributes to the worldwide obesity and type 2 diabetes epidemics is the nutritional value of the meals that people eat on a daily basis. Increasing the intakes of carbohydrates with a high glycemic load (GL) and trans fats is connected with an increased risk of diabetes, but increasing the intakes of cereal fiber and polyunsaturated fats is associated with a decreased risk of diabetes (Liversay et al., 2018). This is the third risk factor to take into account. According to various epidemiological studies, increasing physical activity decreases the chance of developing diabetes, but sedentary behavior increases the risk (Chastin, et al., 2019). Furthermore, research has shown that drinking alcohol and smoking cigarettes increases the chance of developing type 2 diabetes (Yuan, 2020).

Genome-wide Association Studies (GWAS), which were recently introduced, have resulted in significant breakthroughs in the detection of common genetic variants that are connected to the risk of developing diabetes. GWAS Despite the fact that several genes have been related to type 2 diabetes, their effect is minimal and they do not aid in clinical prediction beyond recognised risk factors such as obesity and lack of physical activity, poor diet, and a family history of type 2 diabetes (Duncan, 2019). According to a genome-wide association study (GWAS) conducted in Asian countries, there are considerable interethnic differences in the position and frequency of diabetes risk alleles found in Caucasian populations, notably in Asian ethnicities.

Globalization has also been associated with an increase in the prevalence of type 2 diabetes. Many developing nations are experiencing rapid economic and social development, which has resulted in changes in food habits and way of life for citizens (Ferdiko et al., 2019). Increased consumption and a good energy balance are encouraged by these adjustments. As individuals in Asia get more used to industrialized and urban food environments, they are abandoning their traditional eating practices. The built environment, on the other hand, has become increasingly sedentary in recent years. Increased risk of type 2 diabetes is associated with an increase in body weight and central adiposity that occurs in combination with an increase in physical activity. Since nutrition is changing so quickly, many countries are coping with both over- and under nutrition at the same time. This has resulted in the spread of infectious as well as long-term disorders.

People are more inclined to consume food goods such as edible oil and sugar now that international trade regulations have been loosened. People in India and China, particularly in urban areas, are consuming less cereal than in the past. They have been consuming more refined grains such as rice and wheat, as well as more fat, at all income levels, with the poor eating the most of these foods in particular (Ferniko et al., 2019).

Globalization and economic advancement are altering the nutritional landscape in many developing nations. Intake of high-fat, high-calorie meals has increased, while fiber consumption has decreased, and a preference for fast food has developed. A range of traditional diets from a variety of cultures are now being investigated (Von, 2020).

In order to combat type 2 diabetes, people and organizations from all around the globe are working together. Individuals who participate in one of these support groups learn how to incorporate medical advice into their regular routines. Health results may be improved by providing knowledge and emotional support to others via mutual identification, similar experiences, and a better feeling of belonging to the community (Arney et al., 2020). Multiple studies have shown that social support may help diabetics improve their physical activity, self-monitor their blood glucose levels, eat a more balanced diet, and begin insulin therapy earlier in their disease. People’s ability to control their blood sugar, blood pressure, blood cholesterol, and weight has been found to improve with peer support. A number of studies conducted in China have showed that peer support is effective in the treatment of diabetic patients (Von, 2020).

Diabetes education is recommended by programmers such as the American Diabetes Association’s and the National Institute for Health and Clinical Excellence’s (NICE) Guidelines, both of which are located in the United Kingdom. Patients’ ability to self-manage their diabetes is hampered by a lack of knowledge and empowerment in this area (Arney et al., 2020). Educating diabetes patients who are under informed about their condition or who have limited access to diabetes education may be beneficial for those who are struggling to manage their condition successfully. Several systematic evaluations revealed that combining self-management education with comprehensive lifestyle interventions improved control of hyperglycemia and cardiovascular risk factors. A patient’s ability to think critically and act independently is strengthened through information transmission and patient empowerment. Having the information, resources, and expertise to put their choices into action, as well as the ability to assess and evaluate the outcomes of their actions, gives people the ability to be more self-sufficient. In order to effectively implement no communicable disease prevention programmers, it is critical to keep in mind that health system and governments play a role (Duncan, 2019).

A number of difficulties confront agents aiming to manage and control type 2 diabetes on the other hand (Pamumkas et al., 2019). This group of agents faces a number of similar issues, according to research, such as the type, size and character of the affected region; these issues have all been documented in the literature. Because of the long duration of the disaster, it may be difficult to manage this type of diabetic condition. These are the people who have been affected by this disease. Additionally, local infrastructural and socioeconomic factors have contributed to the difficulty of combating diabetes. The vast majority of the developing world is lacking in preparation measures that could aid in managing, controlling, and combating the situation. The results of a more in-depth investigation revealed that the amount of humanitarian assistance available locally, regionally, and globally was insufficient to manage the illness.

The great majority of the country’s 114 million diabetics have type 2 diabetes. Diabetes medical care is estimated to account for 8.5 percent of China’s total national health expenditures, according to government estimates. Patients with Type 2 Diabetes (T2D) in China who have a lower BMI and are diagnosed at a younger age have a lower risk of developing complications. Type 2 diabetes is one of the most common, expensive, and deadly chronic diseases in the United States, and it affects approximately 30 million people. People with type 2 diabetes accounted for 382 million people in the United States in 2013, but it is estimated that an additional 175 million people are unaware that they have the disease.


As of now, it is predicted that diabetes treatment would account for $490 billion in expenditures by 2030. Obesity and overweight are contributing to the worldwide diabetes epidemic’s rapid progression. Asia, on the other hand, has a lower prevalence of overweight and obesity when compared to Western countries. Due to the changes in dietary patterns and lifestyles brought about by globalization, type 2 diabetes is becoming more prevalent in emerging nations as a result of the spread of the disease. With the fast changes in food intake brought about by globalization, there has been an increase in the incidence of both infectious and chronic illnesses.

Since trade liberalization has increased the availability and affordability of food commodities, such as palatable oil and sugar, more people have access to them. Multiple studies have shown that peer support may be helpful in the treatment of type 2 diabetes. Diabetes and cardiovascular risk factors may be treated more successfully if patients are educated on how to manage their conditions and make lifestyle changes. It is difficult to achieve optimal Type 2 diabetes treatment due to the presence of several roadblocks. In many impoverished nations, for example, there are no policies or procedures in place to monitor, control, or treat Type 2 Diabetes (T2D). Infrastructure and socioeconomic conditions in the surrounding area have also made it difficult to monitor and treat diabetic patients.


Xue, T., Li, Q., Zhang, Q., Lin, W., Weng, J., Li, L., & Chen, G. (2020). Blood glucose levels in elderly subjects with type 2 diabetes during COVID-19 outbreak: a retrospective study in a single center. Available at SSRN 3566198.

Hu, C., & Jia, W. (2018). Diabetes in China: epidemiology and genetic risk factors and their clinical utility in personalized medication. Diabetes, 67(1), 3-11.

Weker, H. (2006). Simple obesity in children. A study on the role of nutritional factors. Medycyna wieku rozwojowego, 10(1), 3-191.

Yuan, G., Al-Shali, K. Z., & Hegele, R. A. (2007). Hypertriglyceridemia: its etiology, effects and treatment. Cmaj, 176(8), 1113-1120.

Mantovani, A., Byrne, C. D., Bonora, E., & Targher, G. (2018). Nonalcoholic fatty liver disease and risk of incident type 2 diabetes: a meta-analysis. Diabetes care, 41(2), 372-382.

Tabish, S. A. (2007). Is diabetes becoming the biggest epidemic of the twenty-first century?. International Journal of health sciences, 1(2), V.

Ginsberg, B. H. (1994). The role of technology in diabetes therapy. Diabetes care, 17, 50-55

El_Jerjawi, N. S., & Abu-Naser, S. S. (2018). Diabetes prediction using artificial neural network. International Journal of Advanced Science and Technology, 121.

Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., … & Shan, P. F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific reports, 10(1), 1-11..

Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., … & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119.

Ide, N., LoGerfo, J. P., & Karmacharya, B. (2018). Barriers and facilitators of diabetes services in Nepal: a qualitative evaluation. Health Policy and Planning, 33(4), 474-482.

Livesey, G., Taylor, R., Livesey, H. F., Buyken, A. E., Jenkins, D. J., Augustin, L. S., … & Brand-Miller, J. C. (2019). Dietary glycemic index and load and the risk of type 2 diabetes: a systematic review and updated meta-analyses of prospective cohort studies. Nutrients, 11(6), 1280.

Chastin, S. F., De Craemer, M., De Cocker, K., Powell, L., Van Cauwenberg, J., Dall, P., … & Stamatakis, E. (2019). How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. British journal of sports medicine, 53(6), 370-376.

Yuan, S., & Larsson, S. C. (2020). An atlas on risk factors for type 2 diabetes: a wide-angled Mendelian randomisation study. Diabetologia, 63(11), 2359-2371.

Duncan, L. E., Ostacher, M., & Ballon, J. (2019). How genome-wide association studies (GWAS) made traditional candidate gene studies obsolete. Neuropsychopharmacology, 44(9), 1518-1523.

Fedacko, J., Takahashi, T., Singh, R. B., Pella, D., Chibisov, S., Hristova, K., … & Juneja, L. R. (2019). Globalization of diets and risk of non communicable diseases. In The role of functional food security in global health (pp. 87-107). Academic Press.

Von Goh, E., Azam-Ali, S., McCullough, F., & Mitra, S. R. (2020). The nutrition transition in Malaysia; key drivers and recommendations for improved health outcomes. BMC nutrition, 6(1), 1-14.

Pamungkas, R. A., Chamroonsawasdi, K., Vatanasomboon, P., & Charupoonphol, P. (2019). Barriers to effective diabetes mellitus self-management (DMSM) practice for glycemic uncontrolled type 2 diabetes mellitus (T2DM): a socio cultural context of Indonesian communities in west sulawesi. European Journal of Investigation in Health, Psychology and Education, 10(1), 250-261.

Gardsten, C., Blomqvist, K., Rask, M., Larsson, Å., Lindberg, A., & Olsson, G. (2018). Challenges in everyday life among recently diagnosed and more experienced adults with type 2 diabetes: a multistage focus group study. Journal of clinical nursing, 27(19-20), 3666-3678.

Case Study: A Middle-Aged Caucasian Man With Anxiety Sample Paper


An investigation and treatment will be carried out on a 46-year-old individual who works as a welder at an adjacent steel production firm. Previously, he had been admitted to the emergency room for what he thought was a heart attack. Throughout the event, he had symptoms compatible with a heart attack. Shortness of breath, chest aches, and an overpowering feeling of dread was all symptoms he was experiencing. A normal electrocardiogram (EKG) was performed during his visit, which ruled out myocardial infarction (MI). A physical check also turned up nothing unusual. An evaluation by a psychiatrist led to his being transferred for further treatment. As a consequence of his desire to “leave,” he’s experienced cardiac and respiratory issues in the past, and he says he’s had comparable experiences in the past. The term “anxiety attacks” was invented by him to describe these bouts of anxiety.

As a result of his mild hypertension, he is also fat, which he controls by eating less sodium. He hasn’t provided further information about his medical history or mentioned any drugs or herbs. He’s a widower who takes care of his aging parents out of pocket. He admitted to downing three to four beers a night to deal with the pressures of his job and the stress it caused him. According to him, his employer was severe, and he was afraid for his job’s safety. He claimed.

In addition to being up and alert, he had exceptional communication skills and a natural ability to express himself. He was afraid, and he admitted it. The effect is minimal in the majority of cases. When confronted with the evidence, he said he was not suffering from mental illness. At this time, there is no known history of suicidal or homicidal tendencies. When the patient was interviewed, he was administered the Hamilton Anxiety Rating Scale (HAM-A), scoring 26. He was diagnosed with Generalized Anxiety Disorder (GAD).

Decision One 

I would start the patient on Zoloft 50 mg daily, Imipramine 25 mg twice daily, or Buspirone 10 mg twice daily from a list of three medicines as a Psychiatric Mental Health Nurse Practitioner (PMHNP). Taking 300 mg of Zoloft per day is the maximum recommended dose. There is a 50-150 mg dose recommendation. It is best to start with the lowest dose feasible and observe the patient’s reaction to it for ethical reasons. If he does have an adverse reaction, at least it will be mild.

Selective serotonin reuptake inhibitors (SSRIs) include Zoloft, Lexapro, and Prozac (SSRIs). In the brain, SSRIs raise serotonin levels. In treating depression, OCD, panic disorder, PTSD and anxiety disorders, Zoloft is a prescription drug. It is available only via prescription. As a result of Zoloft’s ability to block serotonin resorption in the brain, more serotonin is accessible. Anxiety, pleasure, and mood regulation are linked to the neurotransmitter serotonin. The medication causes suicidal thoughts as a side effect. Screening for suicidal ideation or previous suicide attempts in a patient is essential (Allgulander et al., 2015). There is little possibility of these patients harming themselves. He’s not depressed, and he’s never voiced thoughts of taking his own life.

A tricyclic antidepressant, imipramine is used for a wide range of ailments. For example, tricyclic antidepressants are not as well tolerated as second-generation antidepressants. Compared to other GAD medications, tricyclics have more side effects and target more receptors in the body. Thus they are not suggested as a first-line therapy option because of the potential for cardiovascular problems (Zohar & Westenberg, 2000). Anti-anxiety medication Buspirone is used to treat long-term anxiety. As a second-line therapy, it is taken alongside SSRIs. Only when the side effects of SSRIs are judged unacceptable will it be prescribed as an alternative. It is not prescribed as an acute anxiolytic or a long-term anxiety reliever. Four weeks later, he returned to the clinic, his HAM-S score down, no longer experiencing any cardiac or respiratory issues. A partial answer is one with a score ranging from 26 to 18 points.

Decision Two

Increasing my daily Zoloft dosage to 75 mg orally, 100 mg orally, or keeping it the same are my options. As a PMHNP, I’d recommend increasing the daily dosage of Zoloft to 75 mg. If he hasn’t had any significant side effects, I’d want to increase the dosage. He saw a difference after only four weeks. You may prevent unpleasant side effects by gradually increasing the dosage. Start gently because of the positive effects of this medication on this patient.

It’s possible that the patient may become less agreeable with the drug if the dosage is increased to 100 mg orally daily. If a patient stops taking their prescription because they are afraid of the side effects, they are less likely to experiment with other drugs or lessen their dose. Gradual dose increases are preferable from an ethical standpoint. Also, if I want to see further progress, I don’t think I should keep taking the same dosage. It seems that the medication is working, so I plan to gradually raise the dosage to observe if the patient’s symptoms improve. A decrease in symptoms may not be seen in the following four weeks if current dosing levels are not altered. Patients may get discouraged as a result.

Patients who take 75 mg orally daily for four weeks show even better improvement in their symptoms and an improved HAM-A score of 10. In comparison to his previous symptoms, this represents a 61% improvement.

Decision Three

Maintaining the present Zoloft dosage of 75 mg orally daily or boosting it to 100 mg orally daily is now up to the PMHNP. BuSpar may also be used as an augmentation drug (buspirone). If feasible, I’d want to keep my daily dosage of 75 mg by mouth. This is because the patient’s symptoms have decreased by more than 50%, and he has seen no bad side effects due to his treatment so far. Increasing the quantity of medicine you take might cause unwanted side effects. If you’re acting ethically, you should discuss numerous treatment options with the patient. He could feel better if he takes a bigger dose, or he might feel worse and want to stop taking his medicine altogether.

Since the patient’s current treatment has been helpful, you don’t want to add extra medications unless required. For patients on just 50mg of Zoloft, I would usually consider adding another drug to help alleviate their problems. As an alternative, this person responds well to Zoloft and reports an improvement in his symptoms. When used as part of a therapy plan, buspirone may have unwanted side effects. Use the fewest number of medications and the lowest dosage possible to achieve the desired treatment effect. The chance of drug interactions rises directly to prescription volume (Cascorbi, 2012). This is the right thing to do from an ethical sense for the patient. After 12 weeks, you’ll know whether the medication works and if the patient’s symptoms have improved if the patient continues to take it.


Even if you’ve experienced anxiety before, it may be difficult to live and function normally if it persists and gets in the way of routine tasks. Generalized anxiety disorder (GAD) may be helped with medication, though. Drugs for treating generalized anxiety disorder are available in various forms (GAD). As a doctor, you may wish to start the patient on various medications depending on the patient’s age, gender, and ethnicity. Consider their current medications and lifestyle habits, such as drinking and smoking, that may interfere with the medication.

As an SSRI, Zoloft is considered the first-line therapy for generalized anxiety disorder (GAD). Given that he was doing well, I decided to keep him on his medication and only increase the dose by 25mg per day. There were no significant side effects, so I decided to retain him on the 75mg Zoloft dosage. As a test, he plans to continue taking that amount for another 12 weeks to see how well he tolerates it.

Educating patients on the risks and benefits of psychotropic medications is essential when starting them. Adverse reactions from these medications should be reported immediately. While it’s important to stick with working treatment, certain medications need to be gradually weaned off to avoid unpleasant side effects. Patient participation in decision-making is essential so that they may be more actively involved in their care. Patients who feel like they have a say in the therapy they get are more likely to be forthcoming and cooperative throughout their treatment.


Allgulander, C., Dahl, A., Austin, C., Morris, P., Sogaard, J., Fayyad, R., Rynn, M. (2015, January 24). Efficacy of Sertraline in a 12-Week Trial for Generalized Anxiety Disorder. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.161.9.1642#:~:text=Inconclusiontheresultsof,psychicandsomaticanxietysymptoms.

Cascorbi I. (2012). Drug interactions–principles, examples and clinical consequences. Deutsches Arzteblatt international, 109(33-34), 546–556. https://doi.org/10.3238/arztebl.2012.0546

Zohar, J., & Westenberg, H. G. (2000). Anxiety disorders: a review of tricyclic antidepressants and selective serotonin reuptake inhibitors. Acta psychiatrica Scandinavica. Supplementum, 403, 39–49. https://doi.org/10.1111/j.1600-0447.2000.tb10947.x