Diabetes type 2 (T2D)

Part 1: Selection of 15 Articles
Select 15 empirical articles related to your PICOT question. Use the “Empirical Research
Checklist” worksheet to ensure that each article you select meets all of the established
criteria. At least one article must demonstrate a quantitative methodology.
Part 2: Research Article Chart
Using the articles acquired in Part 1, provide a summary review of each component using
the “Research Article Chart” template.
Part 3: Literature Review
Prepare a Literature Review (Chapter 2) of 2,000-3,000 words for your scholarly project.
Utilizing the major concepts identified in the Topic 4 assignment, further develop each
major concept and subtheme by locating 15 more empirical articles related to your project
topic (30 articles total: 15 from Topic 4 assignment and 15 from Topic 6 assignment).
Use the “Research Article Chart” as a guide to analyze and synthesize (summarize) the
literature into the paper you began in the Topic 4 assignment.
Based upon your review of the 15 additional research articles, expand on your summary of
each major concept and your synthesis of the three identified subthemes that support each
concept. At the end of each major concept, include a summary statement.

Benchmark – Drafting a Literature Review

Patient education is management approaches for diabetes type 2 (T2D). The aim of
diabetes patient education is to enable the patients’ ability for symptomatic control, improve the
patient quality of life, achieve behavioral change, prevent complications and improve the patient
knowledge, attitude and healthy lifestyles (Franciosi, Pellegrini, De Berardis, Belfiglio,
Cavaliere, Di Nardo, & Valentini, 2015). The following essay is a discussion of three subthemes

BENCHMARK – DRAFTING A LITERATURE REVIEW 2

under each of the above listed significant concepts in relation to the PICOT question: Do African
American male aged 30-65 suffering from diabetes mellitus type 2 improve their health when
staying in compliance with their medications and adhering to education on how to manage the
disease as compared to when they do not receive the proper education on diabetes and options to
help them better manage the disease other than taking their medications?
Symptomatic Control
Blood Glucose Control. Maintaining blood glucose is one of the aims of patient
education for T2D patients.
The research question of the study by ADVANCE Collaborative Group (2018), was:
what is the effect of the T2D patient’s education on fasting blood sugar control?
The research population sample comprised of elderly aged 50 to 60 years, Africa
American male patients diagnosed with T2D and on follow up care.
The study was limited in that it did not account for other factors towards glycemic control
such as medication.
The study concluded that patient education was associated with normal fasting blood
sugar levels and recommended continued clinicians’ support through patient education to
improve glycemic control among T2D patients.
Glycosylated Hemoglobin Control (A1C). Abnormally and sustained high blood sugar
levels result in sugar binding onto blood hemoglobin. Therefore, one of the indicators of useful
diabetes type 2 management indicators is through assessing the presence of glycosylated
hemoglobin levels.
A study conducted by Hidvégi & Kovács (2014), investigated the additional effects of
patient education on diabetes care as indicated by A1C levels.

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The research question was: what are the additional effects of patient education on
diabetes care as indicated by A1C levels?
The sample population was made of the African American T2D patient aged between 30
and 50 years of age.
The results of the study are limited in that small increase in the level of blood sugar may
not be reflected as A1C and therefore not detected as abnormal blood sugar levels.
The study concludes that patient education on diabetes self-management positively
impacts on A1C levels and recommends the early beginning of patient education to increase the
outcomes. The study further recommends research studies to investigate other factors that may
determine the glycosylated hemoglobin level across patients from other age groups, races, and
social, economic backgrounds.
Medication Adherence. Antidiabetic medication maintains blood sugar within a
reasonable range, and thus adherence is a critical component of patient education.
Becker, Teixeira, Zanetti, Pace, Almeida, & Torquato, (2017) conducted a study whose
research question was: what is the impact of patient education on medication adherence as
indicated by symptoms of blood glucose and A1C levels?
The study population sample comprised of patients aged above 40 years and less 50 years
of age diagnosed with T2D and on anti-diabetic medication.
The study was limited since it did not put into an account for effects of social,
demographic and health-seeking behavior on medication adherence.
The study concludes that education on adhering to medication and self-care modalities
improve the level patient’s detection and control of diabetic symptoms. The study on
glycosylated hemoglobin recommends that future studies should focus on A1C levels in diabetes

BENCHMARK – DRAFTING A LITERATURE REVIEW 4

among other patient population groups across other races, ages, and social and cultural
backgrounds.
In summary, the diabetes patient’s education determines the ability to detect impending
warning symptoms of diabetes and therefore control them. Therefore, determining the ability of
the manifestation of the symptoms of the abnormally high blood sugar level is an appropriate
approach towards assessing the effectiveness of patient education programs on self-care.
Quality of Life
Self-care. The aim of diabetes patient education on self-care is to increase the
independence of the patient to provide care for themselves.
Ricci-Cabello, Ruiz-Pérez Rojas-García, Pastor Rodríguez-Barranco, & Gonçalves,
(2014) conducted a research study whose research question was: what is the level of
effectiveness of diabetes patient education on self-care characteristics and costs effectiveness?
The study sample was made of 37 peer-reviewed studies which evaluated the level of
self-care in patients who had received education on diabetes care.
The study was limited in that it did measure the effectiveness of an education program on
cardinal indicators such as blood sugar levels.
The study concludes that patient education increases the patient’s knowledge on self-
management and therefore positively impacts on behavioral characteristics of the affected
patients. The study proposes the consideration of factors that affect the ability of the patient to
implement their self-care measures.
Activities of Daily Living. Another aim of diabetes patient education is to promote the
social, occupational and interpersonal functioning of the affected patient.

BENCHMARK – DRAFTING A LITERATURE REVIEW 5

A study by Norris, Engelgau, & Narayan, (2013) research addressed the research
question: what is the effectiveness of patient education on the patient’s functionality at old age?
The study population consisted of diabetic patients aged between 50 and 65 years of age
of African American background diagnosed with T2D.
The study was limited since it did not account for the effects of other factors on the
ability to perform activities of daily living.
The researchers concluded that performance activities of daily living should be assessed
about the patient’s knowledge gained through patient education. The study proposes more studies
to determine the appropriateness of cognitively oriented approaches towards self-care modalities
for diabetes type 2 patients.
Mortality Rates. The ineffective treatment of type 2 diabetes leads to the occurrence of
complications such as cardiovascular conditions that ultimately cause death. Therefore, studying
mortality rates among diabetes type 2 patients is a way of establishing the effectiveness of
patient education as a treatment approach against type 2 diabetes.
A study conducted by Bosworth, Olsen, Dudley, Orr, Goldstein, Datta, & Oddone,
(2014), was conducted and the research question was: what is the relationship between patient
education and mortality rates among African America males aged 50-55 years?
The study sample comprised of patients’ records to establish the educational program on
diabetes for all mortality cases related to T2D.
The results of the study are limited since more common mortality causes have not been
accounted for in the study.
The researchers concluded that in order to reduce diabetes type 2 related mortality cases,
patient education should address comorbid factors such as hypertension. The study requires

BENCHMARK – DRAFTING A LITERATURE REVIEW 6

further studies to investigate the contribution of each of the complications towards the cause of
mortality cases among T2D patients.
In summary, the quality of life is measured regarding the ability to meet self-care needs,
the performance of activities of daily living and mortality rates. Patient education affects all the
three indicators. Generally, patient education positively affects the three indicators.
Behavioral Change
Diet. The T2D patient should have specially prescribed diet to control blood glucose
level and maintain the body mass index within the normal range (Coppola, Sasso, Bagnasco,
Giustina, & Gazzaruso, 2016).
The research question was: what are the anthropometric measures for diabetes type 2
patients who received self-management education?
The study population consisted of patients from minority groups in the USA including
African American males, aged 53 years.
The applicability of this study is limited since it does not measure the level of lipid as a
measure of body weight gain in the body through laboratory investigation.
The authors concluded that patient education is associated with structured loss of body
weight and self-monitoring of body weight. Notably, the type of diet is affected by culture. The
researchers recommend future studies to focus on the interplay between self-care education, diet
and culture on the overall self-care in diabetes type 2 cases.
Physical Exercises. Hu, Barengo, Tuomilehto, Lakka, Nissinen, & Jousilahti, (2014),
conducted a research study to investigate the effect of the patient self-management program on
control of blood pressure through physical exercises.

BENCHMARK – DRAFTING A LITERATURE REVIEW 7

The study sample was African Americans, of male gender aged between 60 and 65 years
who had been undertaking patient education for six months.
The researchers concluded that diabetes type 2 patients education has an impact on
control of blood pressure.
Weight Control. Weight management is one of the approaches to prevent the occurrence
of complications in T2D patients.
A study by Mayer-Davis, D’antonio, Smith, Kirkner, Levin Martin, Parra-Medina, &
Schultz, (2015), investigated the correlation between physical exercises and the patient education
program.
The research question for the study was: what is the relationship between the educational
program on self-management and physical exercise performance to control weight among adult
male African American Diabetic patients?
The study sample populations consisted of African American patients aged between 55
and 65 years diagnosed with diabetes type 2.
Behavioral changes as a result of patient education on management of T2D affect the
patient’s diet, ability to perform physical exercise and control of body weight. Behavioral
changes affect the risk of exacerbation of symptoms, and the occurrence of complications.

Prevention of Complications
Prevention of CVD.CVD is a comorbid condition that occurs as a complication of T2D.
Nirantharakumar, Saeed, Wilson, Marshall, & Coleman, (2013) carried out a study whose
research question was: What is the impact of the diabetes patient education on the fiber diet and

BENCHMARK – DRAFTING A LITERATURE REVIEW 8

saturated fatty acids and the prevalence of CVD among the male adult African American
population?
Researchers conclude that education on fiber and the fatty acid diet on the occurrence of
CVD and recommend further research to on the topic for a prolonged period.
Hypertension Prevention. A study by Rodríguez-Mañas, Bayer, Kelly, Zeyfang,
Izquierdo, Laosa, & Sinclair, (2014) investigated hypertension, and the research question was:
what are the effects of provider education support on controlling blood pressure?
The sample population was male African American diagnosed with type 2 diabetes and
under the patient education monitoring program.
The study was limited in that in that it did not establish a baseline history and assessment
of raised blood pressure.
The research study concluded that behavior intervention through patient education
contributed to blood pressure monitoring by the patient. The study recommends establishments
of other factors that contribute to hypertension except for the lack of patient knowledge on self-
management of diabetes type 2.
Hospitalization. Complications resulting from poor self-management of diabetes type 2
such as diabetic foot may require hospitalization in order to manage the condition under close
observation effectively.
A study was conducted to establish the prevalence of diabetic foot after patient education
on preventive measures. The research question was; what is the prevalence of hospitalization due
to diabetic foot?
The study sample consisted of T2D patients diagnosed with diabetic foot receiving
treatment.

BENCHMARK – DRAFTING A LITERATURE REVIEW 9

The study does not demonstrate a level of utilization of knowledge from patient
education program on self-management of diabetes.
The researchers concluded that patient education reduced the prevalence of diabetic foot
and amputation and recommended educating patients on early recognition of developing diabetic
foot (Schoenaker, Toeller, Chaturvedi, Fuller, & Muthu, 2014).
Knowledge, Attitude, and Practice
Knowledge. Patient education programs are contents that increase the patient’s level of
knowledge on self-management.
Schumann, Sutherland, Majid, & Hill-Briggs, (2013), conducted a study whose research
question was: what is the effect of cognitive training on self-management and disease control?
The study sample was composed of 10 African American patients under the cognitive
training of self- diabetes care aged between 35 and 40 years.
The study was limited by the inability to determine the contribution of other causes of
death of affected patients.
The study concludes that cognitive training increases the ability on problem-solving and
self-care skills and recommends future studies to focus the effect of patient education knowledge
on each of the indicators of type 2diabetes.
Attitude. Patient education has an impact on the patient’s attitude on self-management of
T2D.
The research question was: what is the impact on patient’s education on glycemic control
on self-management?
The study sample was composed of African Americans aged 50 to 60 years.

BENCHMARK – DRAFTING A LITERATURE REVIEW 10

The study limitation was lack of baseline data on patient’s attitude and thus observation
of the change after that.
The researchers concluded that patient education increases the attitude and thus the
ability for self-care and suggested further study to investigate the impact of other patient
education elements on attitude towards self-management (Dorresteijn, Kriegsman, Assendelft, &
Valk, 2014).
Practice. Continued education aims at establishing abilities and habit to carry out self-
care for diabetes management.
In a study to investigate the continued practice of self-diabetes management by affected
patients, researchers formulated research question: what is the change in the practice of self-care
as determined by patient education?
The sample size involved in the study was African Americans aged 50 to 60 years
enrolled in the patient education program.
The study was limited in that it did not consider other factors are contributing to change
in attitude.
The researchers concluded that patient education positively influences attitude on patient
self-care (Schaper, Van Netten, Apelqvist, Lipsky, &, Bakker, 2016).
In summary, patient education increases the level of knowledge, attitude, and practice of
the skills taught in implementing self-care aiming T2D patients.
In conclusion, several studies have been conducted to determine the management of type 2
diabetes. Indicators to measure the impact of patient education programs on T2D can be broadly
classified under the concepts and sub-themes discussed. Patient education generally has a

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positive impact on the indicators, but several patient factors determine the extent of the effect of
various indicators.

References

ADVANCE Collaborative Group. (2018). Intensive blood glucose control and vascular outcomes
in patients with type 2 diabetes. New England journal of medicine, 358(24), 2560-2572.
Becker, T. A. C., Teixeira, C. R. D. S., Zanetti, M. L., Pace, A. E., Almeida, F. A., & Torquato,
M. T. D. C. G. (2017). Effects of supportive telephone counseling in the metabolic

BENCHMARK – DRAFTING A LITERATURE REVIEW 12

control of elderly people with diabetes mellitus. Revista brasileira de enfermagem, 70(4),
704-710.
Bosworth, H. B., Olsen, M. K., Dudley, T., Orr, M., Goldstein, M. K., Datta, S. K., … & Oddone,
E. Z. (2014). Patient education and provider decision support to control blood pressure in
primary care: a cluster randomized trial. American heart journal, 157(3), 450-456.
Coppola, A., Sasso, L., Bagnasco, A., Giustina, A., & Gazzaruso, C. (2016). The role of patient
education in the prevention and management of type 2 diabetes: an overview. Endocrine,
53(1), 18-27.
Dorresteijn, J. A., Kriegsman, D. M., Assendelft, W. J., & Valk, G. D. (2014). Patient education
for preventing diabetic foot ulceration.
Franciosi, M., Pellegrini, F., De Berardis, G., Belfiglio, M., Cavaliere, D., Di Nardo, B., … &
Valentini, M. (2015). The impact of blood glucose self-monitoring on metabolic control
and quality of life in type 2 diabetic patients: an urgent need for better educational
strategies. Diabetes Care, 24(11), 1870-1877.
Hidvégi, T., & Kovács, G. (2014). The effect of patient education on glycemic status and self-
monitoring activity in type 2 diabetic patients recently switched to basal insulin analogue
treatment. Orvosi hetilap, 155(43), 1713-1721.
Hu, G., Barengo, N. C., Tuomilehto, J., Lakka, T. A., Nissinen, A., & Jousilahti, P. (2014).
Relationship of physical activity and body mass index to the risk of hypertension: a
prospective study in Finland. Hypertension, 43(1), 25-30.
Mayer-Davis, E. J., D’antonio, A. M., Smith, S. M., Kirkner, G., Levin Martin, S., Parra-Medina,
D., & Schultz, R. (2015). Pounds off with empowerment (POWER): a clinical trial of
weight management strategies for black and white adults with diabetes who live in

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medically underserved rural communities. American journal of public health, 94(10),
1736-1742.
Nirantharakumar, K., Saeed, M., Wilson, I., Marshall, T., & Coleman, J. J. (2013). In-hospital
mortality and length of stay in patients with diabetes having foot disease. Journal of
Diabetes and its Complications, 27(5), 454-458.
Norris, S. L., Engelgau, M. M., & Narayan, K. V. (2013). Effectiveness of self-management
training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes
Care, 24(3), 561-587.
Ricci-Cabello, I., Ruiz-Pérez, I., Rojas-García, A., Pastor, G., Rodríguez-Barranco, M., &
Gonçalves, D. C. (2014). Characteristics and effectiveness of diabetes self-management
educational programs targeted to racial/ethnic minority groups: a systematic review,
meta-analysis and meta-regression. BMC endocrine disorders, 14(1), 60.
Rodríguez-Mañas, L., Bayer, A. J., Kelly, M., Zeyfang, A., Izquierdo, M., Laosa, O., … &
Sinclair, A. J. (2014). An evaluation of the effectiveness of a multi-modal intervention in
frail and pre-frail older people with type 2 diabetes-the MID-Frail study: study protocol
for a randomised controlled trial. Trials, 15(1), 34.
Schaper, N. C., Van Netten, J. J., Apelqvist, J., Lipsky, B. A., Bakker, K., & International
Working Group on the Diabetic Foot (IWGDF). (2016). Prevention and management of
foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the
IWGDF Guidance Documents. Diabetes/metabolism research and reviews, 32, 7-15.
Schoenaker, D. A. J. M., Toeller, M., Chaturvedi, N., Fuller, J. H., Soedamah-Muthu, S. S., &
EURODIAB Prospective Complications Study Group. (2014). Dietary saturated fat and
fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic

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patients: the EURODIAB Prospective Complications Study. Diabetologia, 55(8), 2132-
2141.
Schumann, K. P., Sutherland, J. A., Majid, H. M., & Hill-Briggs, F. (2013). Evidence-based
behavioral treatments for diabetes: problem-solving therapy. Diabetes Spectrum, 24(2),
64-69.

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