Type 2 Diabetes among African American age 45 and above

Type 2 Diabetes among African American age 45 and above

Type 2 Diabetes among African American age 45 and above

Starting this week we will be working on an Evaluation Table in Week 6. With a minimum of 5 articles you must review the literature to find appropriate articles to support your evidence-based project. Each article will be go through the critical appraisal process.

Complete Evidence Table as described in the Evidence Table Worksheet. Include Week 4 worksheet with completed Evidence Table.(SEE BELOW TABLES).

 

These are the formats & my PICOT QUESTIONS BELOW.

1: PICOT QUESTION:

Will African American at North East Georgia Medical Center from age 45 and above diagnosed with diabetes type II since January (P), receiving ongoing nurse-led diabetic education in addition to Hospital discharge education on diet, exercise, and blood glucose monitoring (I), compared with other group of middle-aged African American who only receive education, diet, exercise instructions and glucose monitoring logging four times a day (C) attain a hemoglobin A1C less than 6 over the period of 9 months? (T).

1. Will you have a comparison group or will subjects be their own controls? Comparison
2. Is a ‘time’ appropriate with your question—why or why not?

Type 2 Diabetes among African American age 45 and above

11: Evidence Synthesis:

 

Database	Study #1	Study #2	Study #3	Study #4	Study #5	Synthesis
Population(P)
Intervention(I)
Comparison ©
Outcome (O)
Time (T)

 

III. Evaluation Table

Citation	Design	Sample size: Adequate?	Major Variables: Independent Dependent	Study findings: Strength and weaknesses	Level of Evidence	Evidence synthesis

 

Complete Evidence Table as described in the Evidence Table Worksheet. Include Week 4 worksheet with completed Evidence Table.(SEE ABOVE TABLE).

Type 2 Diabetes among African American age 45 and above

EVIDENCE_TABLE_WORKSHEET_SAMPLE

Evidence Table Worksheet

Student’s Name

University Affiliation

NSG 6999

1. PICOT QUESTION:

In geriatric patients with Type II diabetes (P), does having a diabetic nurse educator (I) compared to not having a diabetic nurse educator (C) decrease hypoglycemic episodes of self-management (O) during a six-month time frame (T)?

1. Will you have a comparison group or will subjects be their own controls?

The research will use a comparison group to assess hypoglycemic episodes between geriatric diabetic patients who have a diabetic nurse educator and those not having an educator. The comparison will analyze outcomes to guide decision on the implementation of self-management to improve quality outcomes to the elderly patients diagnosed with diabetes.

1. Is a ‘time’ appropriate with your question – why or why not?

Yes. It is important to have a time limit in the clinical question considering that aspects of self-management need to be assessed in relation to confounding variables of hypoglycemic frequencies. In essence, time limit enhances a cohesive tracking of self-management practices to make a logical conclusion about the benefit of the intervention to the target population. Time in the clinical question helps to maximize the internal reliability of the given research to improve its applicability in patient care.

1. Evidence Synthesis:

Database: ex. Cochrane	Study #1 Bhutani et al., (2015).	Study #2 Gagliardino et al., (2019).	Study #3 Hope et al., (2018).	Study #4 Sinclair et al., (2019).	Study #5 Yong et al., (2015).	Synthesis
Population (P)	137 diabetic elderly patients attending out-door facility of the hospital.	1316 adult participants with diabetes mellitus enrolled into the International Diabetes Management Practice Study (IDMPS)	335 Diabetic patients aged >65 years	10 study articles evaluated aspects of diabetes care for older adults (60-90 years)	20 men aged between 35 to 75 years and diagnosed with type 2 diabetes.	All the participants were adults or elderly patients diagnosed with type 2 diabetes and most of whom were on a previous diabetes intervention program.
Intervention (I)	Patients treated with oral hypoglycemic drugs; health education on hypoglycemia	Participants enrolled in a diabetes education program	From the total study populations, 79 patients were treated with insulin, 85 on sulphonylureas while 121 received metformin only and 50 participants had no diabetes.	Data was searched from CINHAL, MEDLINE, Embase and Google Scholar to retrieve relevant review articles on the management of type 2 diabetes for older people.	Participants received intensive individualized diabetes education program to influence prevention of hypoglycemic events.	With exception of one study, all the four articles focused on the use of diabetes education as an intervention strategy on self-care for the target population diagnosed with type 2 diabetes. The other study was more of the use of pharmacologic agents to respond to the complications of diabetes.
Comparison (C)	Diabetes care education on hypoglycemic control compared with actual practice among the population	Self-management care was compared between diabetes-educated group and non-educated groups.	Insulin treated patients were compared with sulphonylurea-treated patients and metformin-only treated patients together with patients without diabetes to assess the episodes of documented hypoglycemia.	Up-to-date summaries of articles on glycemic control and outcome in older people with type diabetes were compared by analyzing glucose-lowering interventions with other care outcomes. This aimed to provide evidence-based individualized diabetes care.	Differences in hemoglobin A1c values were identified between the control group (CG=22) and intervention group (IT=24) attending follow-up visits at 2,8,12 and 24 weeks.	Distribution of simulated participants receiving diabetes education was compared with those not receiving the intervention to determine predictive numeric checker for future adoption in clinical setting.
Outcome (O)	Improvements in knowledge, attitude and practice (KAP) of diabetic patients towards hypoglycemia.	Participants who received diabetes education were more likely to practice self-management than those who had not	Hypoglycemia consultation were most common for insulin-treated patients followed by the sulphonylurea-treated patients and finally metformin only-treated patients. Non-diabetic patients recorded the least documentation on the episodes of hypoglycemia. This is attributed to unrecognized hypoglycemia.	Comorbid burdens among the elderly diabetic patients reduces the benefits of improved glycemic control.	The intervention group demonstrated better practices in avoidance of hypoglycemia when compared to the control group. This include adherence to frequencies of physical exercise, improved dietary habits and self-monitoring of blood glucose.	Study participants were assessed on the episodes of hypoglycemia to determine the effective of diabetes education for effective implementation.
Time (T)	1 month	22 months	1 year	Articles published within the past five years	24 weeks	Subjects were observed as per the respective time to monitor outcomes. Besides, follow-up was made on the target population to evaluate the effectiveness of the intervention program. Study duration above 6 months was adequate to assess the quality outcomes as per the given intervention. Those beyond one year provided results that were reliable to guide decision on implementation in clinical practice.

 

1. Evaluation Table:

Citation	Design	Sample size: Adequate?	Major Variables: Independent Dependent	Study findings: Strength and Weaknesses	Level of Evidence	Evidence synthesis
Bhutani et al., (2015).	Longitudinal study design	Sample size used was adequate. Actual study used 109 patients (male=63, female=46)	Independent: Diabetes care education Dependent: Improvements in KAP of diabetic patients towards hypoglycemia	Proper diabetic education improves knowledge, attitude of patients towards practice aimed at decreasing hypoglycemic episodes in diabetics. Strength: The study compared hypoglycemic symptom score with the Stanford reference score to assess influence of diabetic education on the patients. Ensured reliability of study outcomes. Weakness: study used a limited duration (1-month) not adequate for monitoring behavior change. Symptoms as judged by Stanford score were not backed with biochemical confirmation to affirm glycemic changes.	I	Research is based on experimental study to determine baseline information about knowledge, attitude and practices on hypoglycemia. Patient received diabetic information from the treating doctor on hypoglycemia, symptoms and prevention. Occurrence of hypoglycemia compared before and after diabetic education.
Gagliardino et al., (2019).	Cross-sectional study design	The study population was adequate to assess behavior change	Independent: Self-management education (self-monitoring of blood glucose, self-adjustment of insulin dose) Dependent: Attainment and maintenance of glycemic targets Type 2 Diabetes among African American age 45 and above	Diabetes education provides knowledge and skills to improve self-management thereby favoring HbA1c target attainment. Strengths: Use of large sample size and a standardized method of data collection ensured that outcomes provide objective outcomes for decision makers and health authorities on the importance of diabetes education and self-management to improve treatment outcomes. Weakness: The research implemented observational study among participants across different cultures in Middle East and this was not an effective design to assess outcomes about knowledge and skills on self-management due to a lack of active participation among the study population.	I	The study used logistic regression analysis to identify predictive factors in self-management based on diabetes education and the need for glycemic control among the target population.
Hope et al., (2018).	Cross-sectional survey	Sample size adequate and appropriate for the study.	Independent: Primary care practice on patients Dependent: Numbers of hypoglycemia consultations by both diabetic and non-diabetic patients.	Non-specific symptoms of hypoglycemia are a common presentation to primary care especially in people above 65 years with or without diabetes. Insulin-treated patients above 65 years have a higher episode of recognized hypoglycemia as compared non-diabetic patients who represent unrecognized hypoglycemia. Strengths: Use of primary care consultation records guaranteed consistency and reliance of the outcomes. Weakness: Inaccuracy of the outcomes especially due to the use a single primary care record which implies that outcomes on the episodes of hypoglycemia consultation could have been artificially elevated.	I	The study was based experimental research to monitor the episodes of hypoglycemia consultations between diabetic patients given different therapy options and those without diabetes.
Sinclair et al., (2019).	Randomized Control Trials	Study articles used were adequate to predict the patterns of glycemic control among the elderly patients with type diabetes.	Independent: Non-pharmacologic diabetes interventions Dependent: Improved glycemic control. Type 2 Diabetes among African American age 45 and above	From the studies, intensive glycemic control is important for older people with diabetes. These include the use of pharmacologic or non-pharmacologic interventions. Strength: The studies selected contributed strongest evidence on the aspect of glycemic control for elder patients with type 2 diabetes. Weakness: Some articles used weak study designs and this contributed to a high attrition rates in the overall outcome.	V	Study articles selected included clinical reviews that incorporated interventional, observational or descriptive data obtained from people with diabetes enrolled on educational programs. It includes literature analysis and expert opinion to describe a range of non-pharmacological glucose lowering therapies.
Yong et al., (2015).	Randomized control trials	The study population was 55 and this is not adequate to formulate an evidence-based practice for implementation in clinical setting. A population more than 100 would provide a bundle of evidence to evaluate outcome as it affects a larger intervention group.	Independent: Intensive individualized diabetes education Dependent: Baseline HbA1c based on the episodes of hypoglycemia reported by the target population.	Intensive individualized education on hypoglycemia provided additional benefits as it helped the intervention group to manage blood sugar control. The intervention reinforced the need for healthy life style behavior related to dietary practices and physical exercise pattern to manage blood sugar. Strength: Reinforcement education on diabetes management followed a standard protocol as defined in the education curriculum for self-care. This ensured that intervention of practice was guided by evidence. Weakness: The study included a small number of participants and this is not substantial to draw evidence on practice. The research was based on a limited duration (6-months) to monitor change in behavior. A QOL assessment on hypoglycemia management was not conducted in the research meaning that outcomes of the results could be affected by patient factors such as anxiety, fear or non-adherence to the education p.	I	The study used randomized control trials to analyze hypoglycemic episodes for target populations based on the intensive individualized diabetes education. The hypoglycemic episodes analyzed between the control and intervention groups was vital to affirm the effectiveness of the program. This is because the intervention improved behavior change towards lifestyle habits that enhances care for patients with type 2 diabetes mellitus.

Type 2 Diabetes among African American age 45 and above

References

Bhutani, G., Kalra, S., Lamba, S., Verma, P. K., Saini, R., & Grewal, M. (2015). Effect of diabetic education on the knowledge, attitude and practices of diabetic patients towards prevention of hypoglycemia. Indian journal of endocrinology and metabolism, 19(3), 383. DOI: 10.4103/2230-8210.152781.

Gagliardino, J. J., Chantelot, J. M., Domenger, C., Ramachandran, A., Kaddaha, G., Mbanya, J. C., … & IDMPS Steering Committee. (2019). Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS). Diabetes research and clinical practice, 147, 29-36. DOI: 10.1016/j.diabres.2018.09.008.

Hope, S. V., Taylor, P. J., Shields, B. M., Hattersley, A. T., & Hamilton, W. (2018). Are we missing hypoglycaemia? Elderly patients with insulin-treated diabetes present to primary care frequently with non-specific symptoms associated with hypoglycaemia. Primary care diabetes, 12(2), 139-146. DOI: 10.1016/jpcd.2017.08.004.

Sinclair, A. J., Abdelhafiz, A. H., Forbes, A., & Munshi, M. (2019). Evidence‐based diabetes care for older people with Type 2 diabetes: a critical review. Diabetic Medicine, 36(4), 399-413. DOI: 10.1111/dme.13859.

Yong, Y. M., Shin, K. M., Lee, K. M., Cho, J. Y., Ko, S. H., Yoon, M. H., … & Ahn, Y. B. (2015). Intensive individualized reinforcement education is important for the prevention of hypoglycemia in patients with type 2 diabetes. Diabetes & metabolism journal, 39(2), 154-163. DOI: 10.4093/dmj.2015.39.2.154.