Diabetes a chronic disease

1. What consistencies did you find in the evidence?
2. What inconsistencies did you find in the evidence?
3. What are possible explanations for the inconsistencies?
4. What gaps or holes in the evidence base justify the need for continued work in the
   area?
5. How does the evidence you have found support a practice change?

Synthesize the Best Evidence

From the analysis; it is evident that diabetes is a chronic disease that needs proper coping
strategies in order to manage the disease effectively. This helps in management of symptoms
and delays disease progression. One of these coping strategies is patient empowerment
through education. This will help in ensuring that the patient is well informed about his/her
nutritional requirements and the appropriate lifestyle modifications. From the articles
analysed, they agree on establishing cooperation between the patient and health personnel to
identify the best diabetic education (Steinsbekk, et al., 2012).
The evidence based studies inconstancies are observed mainly on reasons behind the low
patient knowledge. For instance, Inzucchin and colleagues identify that the source of these
challenges are due to unequipped trainers who have insufficient knowledge of education for
patient with diabetes. The trainers fail to identify individual specific needs and address
education program in a generalised structure. This fails to improve patient knowledge
sufficiently. On the other hand, Steinsbekk and colleagues indicate that there is reduced
educational facilities and lack of infrastructures that will facilitate adequate training. The
articles call for funding from the government and no governmental institutions to facilitate

Synthesize the Best Evidence
adequate establishment of resources. Therefore, is need to establish the main source of low
efficacy patient education programs, so as they can be addressed in totality
The possible explanations of these inconsistencies is probably because most of the studies
are done within a small cohort or controlled environment; and in most cases, these beneficial
interventions are not translated to individuals lining outside the community. Although
pertinent in realization of the benefits of the research findings, the translational studies on
role of patient education among diabetic patient is lacking. This poses challenges during
training, and in the identification of the exact causative agent attributable to ineffective
patient education strategies (Inzucchi, et al., 2012).
Although patient education is an important strategy in the National Diabetes Prevention and
Control program, there exist gaps and holes in the evidence based research which justifies the
need to improve knowledge in this research. There lacks necessary investment that will
facilitate its achievement. Additionally, patient education structure is not specific enough. It
fails to identify the exact component of patient education that should be focused on i.e.
Nutritional status or pharmacotherapy. It seems that there is need to conduct a closer
surveillance to develop training programs for diabetic patients to overcome the prevailing
inconsistences and shortcomings that impede effective patient education (Inzucchi, et al.,
2015).
The evidence found supports the identified practice change in that it supports that the main
reason for increased complications among diabetes type 2 patients is reduced knowledge on
coping strategies. There is no treatment for diabetes Type 2; and what should be supported is
providing patient education in all aspects that will regularize the patient habits- including
nutritional habits and medication management (Steinsbekk, et al., 2012).
This will reduce complications attributed to the metabolic control as it will empower the
patient to learn essential information as well as capabilities that will ensure improved quality

Synthesize the Best Evidence
of life. Additionally, it is important to have long term follow-ups to monitor patient
capabilities and address new challenges that they could be facing. Additionally, it is
important to establish a good relationship between the patient, physician and dietician. The
improved monitoring systems will ensure that the education program is structured and also
provide an opportunity to overcome any shortcomings that would prevail (Kayshap et al.,
2013).

Synthesize the Best Evidence
References
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … &
Matthews, D. R. (2012). Management of hyperglycemia 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). Diabetes
care, 35(6), 1364-1379.
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … &
Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a
patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes
Care, 38(1), 140-149.
Kashyap, S. R., Bhatt, D. L., Wolski, K., Watanabe, R. M., Abdul-Ghani, M., Abood, B., …
& Kirwan, J. P. (2013). Metabolic Effects of Bariatric Surgery in Patients With
Moderate Obesity and Type 2 Diabetes Analysis of a randomized control trial
comparing surgery with intensive medical treatment.Diabetes care, 36(8), 2175-2182.
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.