Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example

Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example

Introduction

This assignment aims to identify a clinical health issue and propose an evidence-based intervention to address the health issue. The selected problem idea is diabetes. Diabetes is a chronic health condition that influences the body’s food-energy conversion (Centers for Disease Control and Prevention [CDC], 2021a). When food is ingested, it is broken down into sugar/glucose and released into the bloodstream to provide energy. When the blood sugar level in the bloodstream goes up, the pancreas releases insulin that regulates blood glucose levels (CDC, 2021a). If the body does not respond to insulin or insufficient insulin, excessive sugar in the bloodstream can cause significant health problems, including kidney and heart diseases.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Practice Problem and Question

Diabetes presents as a serious health condition with no cure and has adverse outcomes for psychological, emotional, and physical well-being. Diabetes patients present with risks of vision loss, heart disease, stroke, kidney, premature death, and amputation (Centers for Disease Control and Prevention [CDC], 2021b). The health risks are associated with the chronic rise in blood glucose levels that gradually damages organs. Therefore, research studies on cure, prevention, and management are significant in treating, reversing, and preventing related health complications.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Diabetes is a common condition and is ranked the seventh leading cause of mortality in the United States of America (USA). The number of Americans diagnosed with diabetes has doubled in the last two decades, considering Americans’ increasing overweight and obesity. Statistics indicate that 37.3 million people have diabetes translating to 11.3% of the USA population (CDC, 2022) (CDC, 2021b). About 38% of the United States population has prediabetes, approximately 95% of diagnosed cases have T2D, and 5% have T1D. The statistics indicate that diabetes affects the young and the old, with the elderly (65 years and above) having higher risks.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Diabetes is associated with higher costs at the individual, healthcare, and government level. The rising diabetes costs are expected to rise with the projected burden increasing dramatically until 2050 (Reynolds & Genuth, 2018). Estimating healthcare costs imposed on the government, healthcare providers, employers, and policymakers assess opportunities to improve healthcare services and health outcomes (O’Connell & Manson, 2019). The high costs of diabetes are associated with medical costs of complications, lost productivity, income, and premature death (CDC, 2021b). According to the CDC, the annual cost of diabetes is approximately $327 billion as of 2017. Individuals diagnosed with diabetes spend more than two times in medical expenditure than those without (American Diabetes Association [ADA], 2018). Moreover, individuals, particularly adults with low educational attainment and income. The estimates highlight the direct relationship between diabetes prevalence and costs and the significant burden that diabetes imposes on individuals, families, and society.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Knowledge regarding diabetes prevention and management is crucial for self-care and positive health outcomes. Educating individuals with prediabetes effectively reduces the incidence (Weber et al., 2016). Lifestyle intervention helps prevent glucose disorders in women by preventing unhealthy weight gain and cholesterol intake (Pérez-Ferre et al., 2015; Koivusalo et al., 2016). Telehealth education help improves blood glucose and medication adherence (Kempf et al., 2017). The appropriate intervention for the diabetes pandemic is to provide individualized diabetes education on blood sugar control and weight management for individuals at risk and those diagnosed with type 2 diabetes. Diabetes education aims to help individuals reduce risk factors by adopting recommended food regimens, physical activity, and weight management. Therefore, for an adult with diabetes, does lifestyle education compared to no education improve diabetes management in 12 months? (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Evidence Synthesis of the Literature

PubMed and CINAHL databases were searched for full-text articles on diabetes prevention and management using keywords such as diabetes, education, and management. A key phrase used was “the impact of diabetes education on its management.” Out of 547 articles from the two databases, three articles met the inclusion criteria. Kempf et al. (2017) determined the efficacy of lifestyle education intervention using telemedicine. The authors found that patients achieved significant reductions in CVD risks, body weight, HbA_1c, blood pressure, change in eating behavior, demand for anti-diabetes medication, and quality of life (Kempf et al., 2017). Adachi et al. (2019) developed a structured lifestyle education to transform patients’ dietary intake and provide tailored diet information to patients. The study results proved that diabetes education in primary care settings improves HbA_1c levels.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Hailu et al. (2019) developed a diabetes self-management education led by nurses for self-care, general diabetes knowledge, and self-efficacy. The study results demonstrated the role of diabetes education on diabetes knowledge, foot care, and dietary adherence (Hailu, Moen & Hjortdahl, 2019). Lastly, Koivusalo et al. (2016) aimed to determine the possibility of preventing gestational diabetes. The study results showed a 39% reduction in GDM incidence in pregnant women with high risks of developing the condition (Koivusalo et al., 2016). The findings demonstrate the significance of diabetes education in diabetes prevention and management.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Data-Driven Decision-Making

In recent years, the number of individuals diagnosed with diabetes at the practicum site has risen. Most diabetes cases are related to poor lifestyle habits, including sedentary lifestyle, unhealthy food, overweight, and obesity. 97% of the diagnoses cases are T2D, while the remaining 3% account for T1D and gestational diabetes. Among the inpatient cases, diabetic foot ulcers, breathing issues, and kidney and heart complications are reported. Among the outpatient instances, lack of physical activity and binge eating are common determinants. These statistics suggest the need to find additional measures to improve diabetes management. Such interventions would effectively manage readmission, complications, and the associated healthcare costs at the individual, hospital, and government levels.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

The data from the practicum site mirror those in other clinical settings. Kempf et al. (2017) noted a reduction in HbA_1c levels with telehealth education. Secondary diabetes outcome measures, including body mass, systolic and diastolic blood pressure, CDV health risks, rate of anti-diabetic medication, eating behavior, and quality of life, are also positively influenced (Kempf et al., 2017). Adachi et al. (2013) observed HbA_1c and energy intake reduction, and vegetable intake following diabetes education. Lastly, Hailu et al. (2019) reported improved knowledge of diabetes management and dietary intake following diabetes education.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Information and communication technology plays a crucial role in managing diabetes. At the practicum site, information technologies such as EHRs play a pivotal role in recording and disseminating patient data for intervention decisions (Sarwar et al., 2014). For instance, outpatients use glucometers and continuous glucose monitors (CGM) to monitor and record vital diabetes measures. Moreover, the Epic EHR has a patient portal where patients can exchange their clinical measurements with physicians for a more data-focused intervention. The patient portal also allows physicians to monitor the condition progression, advise/educate, and prescribe medications, lowering medication costs and improving health outcomes.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

The telehealth platform allows patients to adhere to routine interventions over 12 weeks. Crucial treatment considerations such as self-monitoring and mental motivation are enhanced through telehealth. According to Abaza & Marschollek. (2017) use of short message services in diabetes education is associated with increased diabetes knowledge and better management. Mobile apps that support self-monitors blood glucose save time and organize patient data to facilitate sharing with physicians remotely. Such data are crucial in real-time decision-making and consequently improve glycemic control. Other software such as Accu-Chek Aviva Expert recommends insulin dosage and carbohydrate intake based on blood sugar readings. Continuous glucose monitoring (CGM) measures interstitial glucose levels and data in sued to make precise dosage recommendations. Therefore, educating patient includes providing information on how to use these technologies to monitor their vital symptoms, connect with physicians, and make use of provided recommendations to help manage their condition.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Conclusion

            Diabetes is a significant health condition. Diabetes has no cure and contributes to adverse health outcomes on psychological, emotional, and physical well-being. Diabetes is a risk factor for vision loss, heart disease, stroke, kidney, premature death, and amputation (Centers for Disease Control and Prevention [CDC], 2021b). Statistically, 37.3 million people have diabetes, which translates to 11.3% of the USA population (CDC, 2022) (CDC, 2021b). The statistics indicate that diabetes affects the young and the old, with the elderly (65 years and above) having higher risks. Diabetes is associated with higher costs at the individual, healthcare, and government level Reynolds & Genuth, 2018). Therefore, diabetes prevention and management knowledge are crucial for self-care and positive health outcomes. Educating individuals with prediabetes effectively reduces the incidence, improves management, and contributes to better health outcomes. Diabetes education improves diabetes knowledge, HbA_1c levels, foot care, dietary adherence (Weber et al., 2016; Pérez-Ferre et al., 2015; Kempf et al., 2017), and GDM incidence (Koivusalo et al., 2016). Besides, Information and communication technology such as EHRs, telehealth, short message services, and mobile apps play a crucial role in recording and disseminating patients (Sarwar et al., 2014; Abaza & Marschollek. (2017). Therefore, educating patient includes providing information on how to use these technologies to monitor their vital symptoms, connect with physicians, and make use of provided recommendations to help manage their condition.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

References

Abaza, H., & Marschollek, M. (2017). SMS education for the promotion of diabetes self-management in low & middle-income countries: a pilot randomized controlled trial in Egypt. BMC public health, 17(1), 1-19(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example). https://doi.org/10.1186/s12889-017-4973-5

Adachi, M., Yamaoka, K., Watanabe, M., Nishikawa, M., Kobayashi, I., Hida, E., & Tango, T. (2013). Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial. BMC Public Health, 13(1), 1-14. https://doi.org/10.1186/1471-2458-13-467

American Diabetes Association. (2018). Economic costs of diabetes in the US in 2017. Diabetes care, 41(5), 917-928. (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)https://doi.org/10.2337/dci18-0007

Centers for Disease Control and Prevention. (December 2021a). What is Diabetes? Available at: https://www.cdc.gov/diabetes/basics/diabetes.html (Accessed 1 July 2022)

Centers for Disease Control and Prevention. (January 2021b). The Facts, Stats, and Impacts of Diabetes. (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)https://www.cdc.gov/diabetes/library/spotlights/diabetes-facts-stats.html#

Centers for Disease Control and Prevention. (January 2022). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. Available at: https://www.cdc.gov/diabetes/data/statistics-report/index.html (Accessed 1 July 2022)

Hailu, F. B., Moen, A., & Hjortdahl, P. (2019). Diabetes self-management education (DSME)–Effect on Knowledge, self-care behavior, and self-efficacy among type 2 diabetes patients in Ethiopia: A controlled clinical trial. Diabetes, Metabolic Syndrome, And Obesity: Targets And Therapy, 12, 2489(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example). https://dx.doi.org/10.2147%2FDMSO.S223123

Kempf, K., Altpeter, B., Berger, J., Reuß, O., Fuchs, M., Schneider, M., … & Martin, S. (2017). Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care, 40(7), 863-871.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example) https://doi.org/10.2337/dc17-0303

Kempf, K., Altpeter, B., Berger, J., Reuß, O., Fuchs, M., Schneider, M., … & Martin, S. (2017). Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care, 40(7), 863-871. https://doi.org/10.2337/dc17-0303

Koivusalo, S. B., Rönö, K., Klemetti, M. M., Roine, R. P., Lindström, J., Erkkola, M., … & Stach-Lempinen, B. (2016). Gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish Gestational Diabetes Prevention Study (RADIEL), a randomized controlled trial. Diabetes care, 39(1), 24-30. https://doi.org/10.2337/dc15-0511

O’Connell, J. M., & Manson, S. M. (2019). Understanding the economic costs of diabetes and prediabetes and what we may learn about reducing the health and economic burden of these conditions. Diabetes Care, 42(9), 1609-1611. https://dx.doi.org/10.2337%2Fdci19-0017

Pérez-Ferre, N., Del Valle, L., Torrejón, M. J., Barca, I., Calvo, M. I., Matía, P., … & Calle-Pascual, A. L. (2015). Diabetes mellitus and abnormal glucose tolerance development after gestational diabetes: A three-year, prospective, randomized, clinical-based, Mediterranean lifestyle interventional study with parallel groups. Clinical Nutrition, 34(4), 579-585. (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)https://doi.org/10.1016/j.clnu.2014.09.005

Sarwar, T., Seifollahi, S., Chan, J., Zhang, X., Aksakalli, V., Hudson, I., … & Cavedon, L. (2022). The Secondary Use of Electronic Health Records for Data Mining: Data Characteristics and Challenges. ACM Computing Surveys (CSUR), 55(2), 1-40. https://doi.org/10.1145/3490234

Weber, M. B., Ranjani, H., Staimez, L. R., Anjana, R. M., Ali, M. K., Narayan, K. V., & Mohan, V. (2016). The stepwise approach to diabetes prevention: results from the D-CLIP randomized controlled trial. Diabetes Care, 39(10), 1760-1767. (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)https://doi.org/10.2337/dc16-1241

Practice Question: For adults with diabetes (P), lifestyle education (I) compared to no intervention (C) can improve diabetes symptoms (O) in 12 months (T).(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)

Date:  

Article Number	Author and Date	Evidence Type	Sample, Sample Size, Setting	Findings That Help Answer the EBP Question	Observable Measures	Limitations	Evidence Level, Quality
40(7)	Kempf et al. 1 July 2017	RCT	T2Dpatients   n = 202   West-German Centre of Diabetes and Health.	Improved eating behavior, medication adherence, fasting blood glucose, blood pressure, healthy body weight, BMI, reduced CVD risk factor, and enhanced quality of life.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)	Fasting blood glucose (mg/dL) HbA1c (%) Bodyweight (kg)BMI (kg/m2)Systolic and diastolic blood pressure (mmHg) Total and HDL cholesterol (mg/dL)  MES (au) Insulin use (units/day) (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)	High drop-out rate in the control group	Level I, High Quality
467 (2013)	Adachi et al. 14 May 2013	RCT	T2D adult patients N=193 Clinics in Kanagawa	Decrease in mean energy intake and HbA1c  Increase in daily average vegetable intake.	HbA1c %BMIFPGSystolic and diastolic blood pressureLDLHDLTG	Low number of participants.	Level I, High Quality
12: 2489–2499	Hailu et al. 29 November 2019	RCT	T2d Adult patients N=220 Jimma University Medical Centre	Improved diabetes knowledge and adherence to recommendations (dietary and foot care).(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)	DietExerciseGlucose self-monitoringFootcare  Smoking habitAlcohol consumptionKhat chewing.	Limited-resource	Level I, High Quality
39(1)	Koivusalo et al. 1 January 2016	RCT	N=293 Two hundred ninety-three women	Reduced the incidence of gestational diabetes mellitus	Pre-pregnancy BMIPrevious GDM statusGDM incidence	Participant bias	Level I, High Quality

References

Adachi, M., Yamaoka, K., Watanabe, M., Nishikawa, M., Kobayashi, I., Hida, E., & Tango, T. (2013). Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial. BMC public health, 13(1), 1-14. (Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example)https://doi.org/10.1186/1471-2458-13-467

Hailu, F. B., Moen, A., & Hjortdahl, P. (2019). Diabetes self-management education (DSME)–Effect on knowledge, self-care behavior, and self-efficacy among type 2 diabetes patients in Ethiopia: A controlled clinical trial. Diabetes, metabolic syndrome, and obesity: targets and therapy, 12, 2489(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example). https://dx.doi.org/10.2147%2FDMSO.S223123

Kempf, K., Altpeter, B., Berger, J., Reuß, O., Fuchs, M., Schneider, M., … & Martin, S. (2017). Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care, 40(7), 863-871.(Evidence-based Intervention on Diabetes Comprehensive Nursing Essay Example) https://doi.org/10.2337/dc17-0303

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