Evidence Synthesis-Sample Solution

Diabetes is a significant health problem in the United States. 34.2 million Americans have diabetes, which is one in every ten Americans (Centers for Disease Control and Prevention [CDC], 2020). Diabetes is associated with various health impacts, including complications and comorbidities, which cause significant health burdens and costs due to lost productivity for affected individuals and families (Arslanian et al., 2018). Diabetes reduces the government’s income tax revenue, increases the government’s expenditure on healthcare costs and payments of welfare benefits (CDC, 2020).(Evidence Synthesis Essay Example)

Since diabetes is a chronic condition, there is a need for adequate management to prevent further exacerbation and adverse outcomes on quality of life that would reduce productivity and increase expenditure on health services. According to Blasco-Blasco et al. (2020) failure to detect and treat diabetes can lead to consequences, including diabetic foot, retinopathy, kidney or heart disease, or preventable death. Diabetes self-management education (DSME) and behavioral support are intervention measures for diabetes and associated complications (Boels et al., 2019). DSME provides the necessary knowledge and support for diabetes management, including glycemic control, prevention, and management of complications.(Evidence Synthesis Essay Example)

Common complications such as diabetic foot ulcers (DFUs) and chronic venous leg ulcers (CVLUs) are better managed through knowledge dissemination (Veazie et al., 2018). Together, DSME and behavioral support can enable individuals diagnosed with diabetes to live a normal and healthy life without complications. The purpose of this paper is to develop a synthesis of evidence on diabetes as a national health problem using three quantitative study articles and three non-research evidence sources.

Analysis of the Practice Problem

Diabetes is a significant health issue affecting Americans across all age groups. With one in ten Americans having diabetes, the high cost of treatment, particularly with insulin, and the associated health impact on individuals and families, including the local and national government, presents a significant challenge for the government (The Washington Post, 2021). Comorbid conditions and complications such as CVLUs and DFU affect individuals’ wellbeing and quality of life (Wiegard et al., 2017; Boels et al., 2019). For instance, DFU can lead to limb amputation if not treated early and effectively. Comorbid conditions and complications also contribute to financial strain due to the inability to work and costly therapy.  Furthermore, there are various disparities in diabetes risks, including ethnic groups, minorities, and old age acts as crucial risk factors to diabetes (HealthyPeople.gov, 2021), making diabetes a significant national health condition.(Evidence Synthesis Essay Example)

As of 2018, the total number of people diagnosed with diabetes in the USA across all ages was 34.2 million, representing about 10.5% of the total US population (CDC, 2020). Out of this number, 34.1% were adults aged 18 and above, representing about 13% of the total adult population in the USA (CDC, 2020). The CDC report also indicated that about 7.3million adults aged 18 and above me the criterion for diabetes diagnosis, albeit having no information on their health status regarding diabetes. The undiagnosed population alone represented 2.8% of the total US adult population (CDC, 2020). Furthermore, about 88 million of the adult population in the USA had prediabetes as of 2018.

Along racial lines, the prevalence of diabetes is 2 to 5 times higher among Indian Americans than whites, while the prevalence among African Americans is 1.7 times higher than whites (HealthyPeople.gov, 2021). Lastly, the prevalence of diabetes among Puerto Ricans and Mexican Americans is two times higher than white Americans (HealthyPeople.gov, 2021). These numbers reveal the disturbing status of diabetes in the USA and the need for evidence-based intervention measures to preserve and protect life. Diabetes complications and comorbidities cause a high rate of death in the United States. Diabetes was ranked as the seventh leading cause of death in the USA in 2017 (CDC, 2020). 25.7 deaths in every 100,000 persons were attributed to diabetes as the underlying cause (CDC, 2020).

Moreover, diabetes was recorded as the underlying or the contributing factor to 83.1 deaths in every 100,000 persons (HealthyPeople.gov, 2021). It is estimated that the United States incurred direct and indirect costs of $327 billion on diagnosed diabetes in 2017 alone (CDC, 2020). The cost included lost revenue due to diminished productivity, costs of welfare benefits, and supply of medicines and equipment. The direct cost of diabetes in the same year was estimated at $237 billion, a significant increase from $188 billion in 2012 (CDC, 2020). The indirect costs of diabetes were estimated to be $90 billion, an increase from $73 billion in the year 2012. Significantly, the excess medical costs per individual were $9,601 in 2017, increasing by $ 1184 since 2012 (CDC, 2020). About 1.3 million people, which is 12.5 of the population, have diabetes (Illinois Department of Public Health, n.d.).(Evidence Synthesis Essay Example)

Evidence Synthesis

The themes presented in the sources include diabetes self-management and support and the management of diabetes complications and comorbid conditions, including DFUs and CVLUs (Boels et al., 2019; Elsaid et al., 2020; Wiegand et al., 2017). Other themes presented include the rising costs of indulging therapy, the health impact of diabetes on individuals and families (Elsaid et al., 2020; Wiegand et al., 2017). Lastly, the impact of diabetes on the government is attributed to loss of income tax revenue, welfare, and medical costs (Boels et al., 2019).

Elsaid et al. (2019) and Wiengand et al. (2017) provide evidence-based information crucial to managing diabetes complications and comorbid conditions, respectively. Elsaid et al. (2019) focused on managing non-healing diabetic foot ulcers as a significant challenge for those diagnosed with diabetes. Wiengand et al. (2017) focused on managing chronic venous leg ulcers, a complication and comorbid condition among individuals diagnosed with diabetes. On the other hand, Boels et al. (2019) determined the impact of smartphone-enabled digital self-management education and support for diabetic individuals taking insulin therapy.(Evidence Synthesis Essay Example)

The non-research sources focused on outlining the significance of diabetes in the USA and its impact on individuals, families, and the government.  The CDC (2020) presents statistics on the increasing prevalence of diabetes and prediabetes, the associated mortality, risk factors, coexisting conditions, and complications. HealthPeople.gov (2021) provides an overview of diabetes statistics, disparities, risk factors, and significance. Lastly, the Washington Post (2021) presents an expert opinion of the status of diabetes, including the rising cost of insulin therapy and the significance of diabetes as a national health problem. Together, the non-evidence sources present diabetes as a significant health issue, which continues to rise with impacts on the individuals, their families, and the government.

Elsaid et al. (2019) found out that platelet-rich plasma (PRP) effectively treats hard-to-heal DFU. The study found out that dressing diabetic foot ulcers using the PRP promotes healing by reducing the wound surface area and accelerating the healing process. Other factors such as age, type, and ulcer size determine the healing rate. Wiengand et al. (2017) present noncontact low-frequency ultrasound (NLFU) as a crucial therapy to managing diabetes and other types of ulcers associated with diabetes. This research’s central theme is that NLFU is crucial for managing diabetes and associated ulcers by stimulating the growth of cells surrounding the wound to health by promoting blood flow, reducing bacterial cells, and suppressing inflammation (Wiengad et al., 2017). Boels and colleagues (2019) highlighted the role of DSME/S in managing diabetes by acting as a reminder of the diet, physical activity, medication, and motivation to make healthy life choices. Moreover, Boels et al. (2019) noted that DSME/S should be tailored to meet individual needs since every person has unique needs that go unmet by healthcare professionals.

Conclusion

Diabetes is a chronic condition associated with significant health outcomes among individuals, families, and the government. The prevalence of diabetes continues to rise across all ages within the USA. Diabetes affects an individual’s wellbeing and quality of life. Diabetes affects individuals’ productivity and incomes, which reduces income tax revenue for the local and federal governments. Because of these challenges, there is a need to manage diabetes effectively, and self-management and support are considered crucial interventions. With the knowledge of managing complications such as DFU and CVLUs, individuals can live with diabetes and continue working.(Evidence Synthesis Essay Example)

References

Blasco-Blasco, M., Puig-García, M., Piay, N., Lumbreras, B., Hernández-Aguado, I., & Parker, L. A. (2020). Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review. PloS One, 15(9), e0237542. https://doi.org/10.1371/journal.pone.0237542

Boels, A. M., Vos, R. C., Dijkhorst-Oei, L. T., & Rutten, G. E. (2019). Effectiveness of diabetes self-management education and support via a smartphone application in insulin-treated patients with type 2 diabetes: Results of a randomized controlled trial (TRIGGER study). BMJ Open Diabetes Research and Care, 7(1), e000981. http://dx.doi.org/10.1136/bmjdrc-2019-000981

Centers for Disease Control and Prevention. (February 2020). National diabetes statistics report, 2020: Estimates of diabetes and its burden in the United States.  https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Elsaid, A., El-Said, M., Emile, S., Youssef, M., Khafagy, W., & Elshobaky, A. (2020). A randomized controlled trial on autologous platelet-rich plasma versus saline dressing in the treatment of non-healing diabetic foot ulcers. World Journal of Surgery, 44(4), 1294-1301. https://doi.org/10.1007/s00268-019-05316-0

HealthyPeople.gov. (October 2021).  Diabetes. https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes

Illinois Department of Public Health. (n.d.). Diabetes. https://dph.illinois.gov/topics-services/diseasesandconditions/diabetes.html#

The Washington Post. (May 2021). Diabetes in America with Aaron Neinstein, MD, Rita Rastogi Kalyani, MD, MHS & Jennifer Raymond, MD, MCR. https://www.washingtonpost.com/washington-post-live/2021/05/04/diabetes-america/

Veazie, S., Winchell, K., Gilbert, J., Paynter, R., Ivlev, I., Eden, K. B., … & Helfand, M. (2018). Rapid evidence review of mobile applications for self-management of diabetes. Journal of General Internal Medicine, 33(7), 1167-1176. https://doi.org/10.1007/s11606-018-4410-1

Wiegand, C., Bittenger, K., Galiano, R. D., Driver, V. R., & Gibbons, G. W. (2017). Does noncontact low‐frequency ultrasound therapy contribute to wound healing at the molecular level? Wound Repair and Regeneration, 25(5), 871–882. https://doi.org/10.1111/wrr.12595