NURS 3402-001 Nursing Research And Evidence-Based Practice

Literature review

Write pico question on patient with newly diagnosed t2d.

Introduction

Diabetes mellitus is a metabolic disorder in which the blood sugar level in the blood rises along with prolonged high blood pressure. If diabetes is left untreated then it may lead to serious acute conditions such as hyperosmolar hyperglycemic state, ketoacidosis. Long term conditions may include chronic kidney disease, cardiovascular diseases, eye damage and ulcers (Dorresteijn & Valk, 2012). Diabetes is a life style disease and can be maintained by maintaining proper diet and life style. Therefore education is necessary for the proper self management of the disease. It is a common ailment that is found all over the world afflicting more than 30% of the population in almost every country. Due to the wide prevalence of diabetes it is necessary to take first hand actions.

This paper aims to provide a critical research regarding the importance of education to the acute care patients newly diagnosed with diabetes. It is necessary to address a PICO question, in order to perform an evidence based search regarding the importance of education to newly diagnosed patient. In order to do this a comparison has been brought between those diabetic patients with education and without any education.

Each of the PICO terms is described by a wide range of literatures and a literature review is provided supporting the PICO question

P- Newly Diagnosed patients discharged from acute care with type 2 diabetes

I- Educating patients regarding diet, exercise, medication and insulin therapy and regular check up to control diabetes.

C- Compared to patients with no education and not following the recommended practices to control diabetes.

O- Increasing nursing comfort with teaching the information.

The population chosen for this study is the patients with newly diagnosed diabetes who have been recently discharged from acute care.

Management of the glycemic level in acute care patients is critical. Acute care patients with T2D require specific glycemic control protocols. Early diagnosis and proper management of diabetes can reduce the detrimental effects of diabetes to some effect even if it cannot be cured fully (Haas et al., 2012).

This type of population has been taken for the research due to the fact that the acute care patients, who are already under the burden of other ailments, require additional education to manage the effects of diabetes. Further more different studies that patients having diabetes have three fold chances of hospitalization compared to those with diabetes and the chances becomes much higher with the acute care patients. Reports say that here had been 7.7 millions of hospital stays with diabetes. Furthermore since diabetes can be easily managed by maintaining proper diets and exercises and adherence to medications. This population had been suitable for my research.

Literature review

According to the reports by Dorresteijn & Valk, (2012), Hyperglycemia greater than 140mg/dl is reported in22-46% of the non-critically ill patient. The data indicates that patients without the prior diagnosis in patients can increase the risk of complications.

According to the International Diabetes federation, more than 415 million of people are affected with diabetes globally. Most of the detrimental effects of diabetes are associated to the acute care patients.

Reports say that about 70-80% of the patients with critical illnesses have become the victims of the acute care diabetes.

According to Mayberry & Osborn, (2012), in patients without diabetes the plasma glucose level is maintained within the range 70-100mg/dl. Maintenance of the normal glucose level is essential for the proper functioning of the brain.

According to Evert et al., (2014), the primary goal for the study is the rapid evaluation of the disease. Patients who are under acute care should be undergoing a clinical history and physical examination including a metabolic panel. The critical evaluation of this paper is necessary it discusses about the hoe the critically ill patients under acute care should be assessed with diabetes. After the necessary assessments and examinations, the second step to the management of diabetes is imparting education to the patient regarding the management of diabetes.

Diabetes self management education may be considered as the critical element of care for the people with diabetes and is essential in order to improve the outcomes in patients with diabetes. It is necessary to provide an evidence based education to the acute care patients.

According to the paper by Peyrot et al., (2012), Being a newly diagnosed with diabetes can be confusing and precautions and preventions taken from the beginning can really improve the quality of life. At first it is really important to educate the patient regarding the pathophysiology of the disease. They would be taught about the different ranges of the blood sugar level and the level to which he belongs. Then it is necessary to advice the patients to keep the blood sugar close to the normal by effective precautions. The patient should be acquainted with all the knowledge regarding the adverse effects of high blood sugar levels.

According to Evert et al., (2014), the main goal of the diabetic management should include be to recreate the high blood sugar level up to the normal level without causing low blood sugars. Diabetes is of two types, it is necessary for the patients to understand the difference between these two types a the management protocol  varies with these two types, for example the For type 1 diabetes one is treated with insulin replacement therapy and type 2 diabetic patient requires therapies that normalizes the sugar levels.  

To discuss about the interventions regarding the T2D in patients, we have come across a lot of articles while brain storming through the search engines.

According to Malanda et al., (2012), the key principle of the self management of diabetes is the self monitoring of the blood sugar level regularly. There are several blood sugar monitoring devices available in the market to monitor the blood sugar level daily. According to the author, people who monitor their blood glucose levels regularly and maintain a proper log book to maintain the records, achieve better results. Acute cases of diabetes also require keeping a close watch on blood and urine ketones.  

There is portable glucose monitoring devices that can be used to monitor glucose regularly. Newly diagnosed patients should be taught how to use the devices properly. According to Clarke & Foster, (2012), a glycosylated hemoglobin cell that is glucose attached to haemoglobin may remain viable up to three months. Therefore, it is required to measure the average blood glucose control for the last three months as that would help to reflect the sugar exposure to the cells.

Malanda et al., (2012), have argued that the electronic devices are always not effective in monitoring the blood glucose level although there had been a wide spread increase in the sale of different brands of glucose meter.  

As per  Inzucchi et al., (2012), there are curtain therapies which can be taught to the patient to manage the further growth of the symptoms.  Person having T2D can have high blood sugar level right after the meal, even if very less carbohydrate type food is consumed. Medicines called incretin based treatments can be used to control the post meal glucagon, and help to mitigate the post meal blood sugars.

As food plays an important part in the management of diabetes. Careful nutritional assessment is required to control diabetes. According to (Ajala,  English & Pinkney, 2013), the estimated nutritional requirement for the diabetic patients are same as that of the others of the population, but the diets should be exclusively based on the metabolic needs of an individual. Referral to an authenticated dietician can be advised for preparing a proper meal plan for the patient. Emphasis should be given on the non carbohydrate type of food such as dietary fibers and foods containing whole grains. Al-Khawaldeh et al., (2012) have emphasized that low glycemic index food, rich in fibers should be encouraged.

In a population study performed by Inzucchi et al., (2012), revealed that people addicted to alcohols are more prone to diabetes compared to that of the non drinkers. A greater risk ratio indicates that diabetic symptom is directly proportional to alcohol consumption in patients.

Clinical trial data form Finnish Diabetes Prevention study and the Diabetes Prevention Program (DPP) in the U.S has strongly recommended that obesity increases the risk of diabetes in patients, discharged from the acute care. The clinical trials have proved that life style interventions include regular physical activity permissible for the patient and moderate weight loss. Powers et al., (2012) strongly supports the facts that obesity not only increase the risk of diabetes but also increases the chance of other conditions like hypertension and the inflammatory markers.

In case of patients with hypo glycemia, artificial intake of glucose can be taken. For acute diabetes, oral glucose lowering medications and insulin should be continued.

According to Chen et al., (2012) Patients with newly diagnosed acute care diabetes may face challenges during the administration of Insulin. The patient should be educated about the process of application of the injection and the site of injection. The site of injection should be rotated to prevent scarring. The patient should have a knowledge regarding storing of the insulin vials. It is advisable to help the patient for choosing the types of syringe used in the injection. Steinsbekk et al., (2013) suggests that it is necessary to educate the patients regarding the disposal of the insulin syringes and the pens and they should be educated that the insulin syringes should not be shared with anybody else.

For the patients in acute care facilities, it is necessary to set up an interdisciplinary team, implementation of MNT. According to Peyrot et al., (2012), an individual can have pre-diabetes which means that the blood glucose level is greater than the normal range but is lower than the diabetic range. Proper education to patients can reduce the intensity of the diabetes.

According to Davies et al., (2013), the diabetic educators might face with a lot of difficulties as some of the patients might feel embarrassed to admit that they don’t have any knowledge regarding the disease. Therefore it is necessary to built up a relationship of trust, non judgment and emotional safety between the client and the diabetic educator, such that it becomes easier for the acute care patients to pay heed to the instructions.

Powers et al., (2017) has said that Education plays an important role in the Management of diabetes as it assists the patients in managing the disease. The main aim of the self management of diabetes is to turn the patients in to the managers of their disease. The interventions are found to improve the clinical results. The main outcome of educating diabetes patient is to enable them to take their own decisions regarding their treatment and encouraging them to utilize the health system as a means for controlling diabetes. Another important outcome is that it increases the patient autonomy.

As per the author Haas et al., (2012), education to newly diagnosed patients decreases hospital revisits and also helps to curtail health care costs.  Although it is difficult to engage the acute care patients in their own treatment, the families of the patient can be involved in the treatment regimen to provide a safer care to the critical care patients.

According to Das et al., (2013), a randomized control study shows that proper diabetic education in acute care patients prevents complication when compared to the diabetic patients without proper diabetic management education.

Al-Khawaldeh et al., (2012) have noticed the relationship between patient’s literacy regarding diabetes and the progression of chronic diseases. A total of 402 patients with hypertension and diabetes were assessed, out of which symptoms in 114 patients were moderate and rest of the population of the study showed acute diabetic problems. On assessing the patients it was found that 94 out of the 114 students did have knowledge about the self management techniques. The rest of the participants were found to be ignorant regarding the self management education.

Many reports have emphasized on the fact that literary skills of the patient must be considered while care to the patients. The mode of education to the patients should be simple such for the critical care patients to perceive.

Hence it can be said that the literatures that have used in the literature review are appropriate in addressing each of the parameters of the PICO question. The papers provides with the evidences that education in diabetic patients can change the landscape of the disease and result in better outcomes.

Conclusion

The literature review provides with the information that Diabetes is mainly a life style disease and its self management techniques can mitigate the adverse situations related to diabetes. Literatures have provided with evidences that proves that patients having education regarding diabetes have led to faster recovery than those without prior education. The articles used in the literature review could address the type of population chosen and the reason for choosing them for the study. The articles proved how educations can help the newly diagnosed patients to self monitor the glucose levels and administer them timely.  It can be concluded that initial evaluation, a proper management plan, glycemic control and referrals for diabetes management can decrease the adverse effects in patients with acute care diabetes and provide them with a better life style.

References

Ajala, O., English, P., & Pinkney, J. (2013). Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. The American journal of clinical nutrition, 97(3), 505-516.

Al-Khawaldeh, O. A., Al-Hassan, M. A., & Froelicher, E. S. (2012). Self-efficacy, self-management, and glycemic control in adults with type 2 diabetes mellitus. Journal of Diabetes and its Complications, 26(1), 10-16.

Chen, S. M., Creedy, D., Lin, H. S., & Wollin, J. (2012). Effects of motivational interviewing intervention on self-management, psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial. International journal of nursing studies, 49(6), 637-644.

Clarke, S. F., & Foster, J. R. (2012). A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. British journal of biomedical science, 69(2), 83.

Das, S. L., Singh, P. P., Phillips, A. R., Murphy, R., Windsor, J. A., & Petrov, M. S. (2013). Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-analysis. Gut, gutjnl-2013.

Davies, M. J., Gagliardino, J. J., Gray, L. J., Khunti, K., Mohan, V., & Hughes, R. (2013). Real?world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2 diabetes mellitus: a systematic review. Diabetic Medicine, 30(5), 512-524.

Dorresteijn, J. A., & Valk, G. D. (2012). Patient education for preventing diabetic foot ulceration. Diabetes/metabolism research and reviews, 28(S1), 101-106.

Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., … & Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes care, 37(Supplement 1), S120-S143.

Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & McLaughlin, S. (2012). National standards for diabetes self-management education and support. The Diabetes Educator, 38(5), 619-629.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-1596.

Malanda, U. L., Welschen, L., Riphagen, I. I., Dekker, J. M., Nijpels, G., & Bot, S. D. (2012). Self?monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. The Cochrane Library.

Mayberry, L. S., & Osborn, C. Y. (2012). Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes care, 35(6), 1239-1245.

Peyrot, M., Barnett, A. H., Meneghini, L. F., & Schumm?Draeger, P. M. (2012). Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabetic Medicine, 29(5), 682-689.

Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … & Vivian, E. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43(1), 40-53.

Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim, A. (2012). Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC health services research, 12(1), 213.