Type 2 diabetes mellitus patients

PICOT QUESTION

In type 2 diabetes mellitus patients ages 18 and above, can education on medication adherence and lifestyle modifications on their routine office visits improve the fasting blood glucose?

Directions:

Use the “DPI Proposal Template” to help you develop a draft of the Introduction (Chapter 1) of your DPI Project Proposal. Keep in mind this is an outline and formatting structure; it may be of use to you, but recall that each project will vary in nature and scope, so adaptations to this format may be required.

Sections in Chapter 1 include:

1. Introduction

2. Background of the Project

3. Problem Statement

4. Purpose of the Project

5. Clinical Question(s)

6. Advancing Scientific Knowledge

7. Significance of the Project

8. Rationale for Methodology

9. Nature of the Project Design

10. Definition of Terms

11. Assumptions, Limitations, Delimitations

12. Summary and Organization of the Remainder of the Project

Much of this information can be gleaned from your DPI Prospectus, but you will find that new as well as expanded content in specific areas will be required, depending on the nature of your proposed DPI Project.

Improvement of Fasting Blood Glucose in Type 2 Diabetes Mellitus

Direct Practice Improvement Project Proposal

Contents

CHAPTER 1. 3

1.0 Introduction. 3

1.1 Background. 4

1.3 Problem Statement. 5

1.4 Purpose of the Project. 6

1.5 Clinical Questions. 6

1.6 Advancing Scientific Knowledge. 7

1.7 Significance of the Project. 8

1.8 Rationale for Methodology. 9

1.9 Nature of the Project. 9

1.10 Definition of Terms. 10

1.11 Assumptions, Limitations and Delimitations. 10

1.12 Summary and Organization of the Remainder of the Project. 11

Chapter 1

1.0 Introduction

Type II diabetes is an endocrine disease that affects the body metabolism of blood sugar.  The mechanisms involved are either the resistance of the body to the effects of insulin or insufficient production of insulin hormone by the pancreas (Nguyen, 2015). Type II diabetes has no specific cure but lifestyle modifications including weight loss, good dietary patterns, and regular physical exercise can help manage the condition. If the above measures aren’t enough, diabetic medications and insulin therapy can help maintain normal blood glucose levels (Ponzo et al., 2018).

The main aim of this project is to assess if education on medication adherence and lifestyle modifications in Type II diabetes mellitus patients aged 18 years and above having their routine office visits improve their fasting blood glucose levels (Crews et al., 2016; McBrien et al., 2017; Polonsky & Henry, 2016). Compliance is defined as the extent to which an individual’s behavior with respect to drug intake following lifestyle modifications corresponds with the required recommendations from a clinician. Lifestyle modifications of exercising, dieting and weight maintenance are important in the control of Type II diabetes (Kueh, Morris, Borkoles & Shee, 2015).

The project will review past and recent literature concerning Type II diabetes education strategies on medication and lifestyle modifications. This will be followed by a methodology, a description of how the project will be carried out and the necessary tools and methods to be employed. The project will be then be completed with a field study and analysis of the findings on the topic and discussion on the topic.

1.1 Background

The incidence of Type II diabetes mellitus is growing worldwide and is a major WHO global disease of concern. A study of 20,000 people over 18 years indicated that those diagnosed with Type II diabetes had risen from 7% in the year 2010-203 period to 8% in the year 2015-2018 (Kueh, Morris, Borkoles & Shee, 2015). In 2013, 370 million people globally had diabetes and it’s estimated that by 2025, the figure will have increased to 550 million (Zimmet, Alberti, Magliano & Bennett, 2016). Currently, diabetes mellitus is among the top ten causes of deaths worldwide in developed countries and caused an estimated 5 million deaths in 2015 (Perreault, 2017). Type II diabetes causes a majority of cases of diabetes and the highest numbers of individuals with these conditions are aged age 35 to 60 years (Nguyen & George, 2015).

The rise in the cases of Type II diabetes cases is associated with obesity, decreased compliance to medications, unhealthy dietary patterns and the growing elderly population (Kirkman et al., 2015). A study by an NGO in the United States indicated that the number of adults in age group 25 to 75 years with a BMI of over 32 kg/m2has grown from 30 to 40%, while the number of those having regular physical activity twelve times a month had dropped from 55% to 40%, enhancing the obesity problem and the compliance to insulin therapy and diabetic medications had a drop of 95% to 93% (ADA, 2014). The dietary patterns findings suggested that most of the individuals were taking foods high in salt, sugars and cholesterol compounding the diabetes problem (Polonsky & Henry, 2016; Pols et al., 2017). The project focus will be on compliance to diabetic medications and lifestyle modifications education with the outcome of improving the fasting blood glucose levels in these patients (Patel et al., 2016; Pop-Busui et al., 2017).

1.3 Problem Statement

It is known that Type II diabetes occurs more than Type I diabetes with about 92% of these individuals with diabetes having Type II diabetes (McGovern et al., 2016). Individuals with Type I diabetes are not able to produce insulin at all while those with Type II diabetes still produce insulin however the muscle cells, hepatocytes and adipocytes are inefficient in incorporating insulin and can’t regulate the sugar levels well (Perreault, 2017). Type II diabetes is a progressive disease implying that a person will require help in terms of medications and lifestyle modifications (Nyirjesy, 2014).

A study done in the USA indicates that 10% of the US population had diabetes including adults aged 18 years and above. A quarter of individuals who have diabetes do not know they have the condition. The number of individuals with diabetes has tripled between 2000 and 2015 and the number of newly diagnosed cases doubles every day (Klingensmith et al., 2016; Zullig et al., 2015). A report by the CDC found out that 5% of individuals aged 18 to 45 years are living with Type II diabetes, 20% of those aged 46 to 63 years, and 30% of those aged 64 years and above (ADA, 2014).

The project will contribute to solving the problem by advocating for education on Type II diabetes. The education will encompass why it is necessary for patients suffering from Type II diabetes need to be compliant with their medications. It will also focus on why education on lifestyle modifications can help improve Type II diabetes patients. The main outcome is the improvement of fasting blood glucose levels to the near or normal levels.

1.4 Purpose of the Project

The purpose of this project is to find out the role of education on medication adherence and lifestyle medications on Type II diabetic patients. The population to be studied are patients aged 18 years and above. The location of the study will be at……The independent variables are education on medication adherence and lifestyle modifications while the dependent variable is the improved fasting blood glucose levels. The independent variables (education on compliance and lifestyle modifications) will be defined by teaching the patients on ways on the various ways the patients can maintain good compliance to diabetic medications and also give the reasons to why compliance to drugs is necessary to controlling Type II diabetes. Education on lifestyle modifications including exercise patterns, change in dietary patterns, weight reduction will be assessed. The dependent variable will be measured with the outcome which is the improving of the fasting blood glucose to the normal levels of 7mmol/L.

The main contribution of studying education on compliance to the nursing field is that patients will be equipped with the knowledge on diabetes know why they should strive to adhere to their medications to prevent complications associated with type II diabetes mellitus including diabetic retinopathy, diabetic nephropathy, and others. Education on lifestyle changes which many patients can take for granted can have a huge impact on the control of diabetes. (Zaheer, 2019)

1.5 Clinical Questions

The following clinical questions will be used to guide this quantitative project:

Q1: What is the role of education on medication adherence in patients with Type II diabetes aged 18 years and above having their routine office visits improve their fasting blood glucose levels?

Q2. What is the role of education on lifestyle modifications to patients with Type II diabetes aged 18 and above having their routine office visits improve their fasting blood glucose levels?

Q3. What is the significance of having normal fasting blood sugar levels in patients with Type II diabetes aged 18 years and above and having routine office visits?

The first question (Q1) will try to answer the role of education on compliance of diabetic medications by these patients with the aim of improving the fasting blood glucose levels either a low level or near normal. The second (Q2) will try to make an understanding of the relationship between the role of education and lifestyle modifications in diabetic patients towards the achieving of normal fasting blood glucose. The last question (3) will explain the importance of having normal fasting blood sugar levels in Diabetic Type II individuals aged 18 years and above in their daily lives.

1.6 Advancing Scientific Knowledge

The main aim of this project concerning advancing health outcomes related to Type II diabetes mellitus is the lowering the complications and clinical outcomes including death. While aggressive sugar control has many advantages for microvascular endpoints, the relationship between the glucose-lowering approaches and decreased rate and progression of the microvascular complications is less clearly explained (Riccardi, Vitale & Giacco, 2018; Sanchez, Silvestre & Campo, 2018). The project thus will try to explain the role of improving fasting blood sugar in patients with Type II diabetes brought as a result of education on compliance to medications and lifestyle modifications (Abubakari et al,. 2016; Sankar et al., 2018).

The model under which this project is built is the socio-ecological model which states that education is the driving force at each environmental level, from decisions people make to the social position have in the society. In health, the relationship between education and one’s well-being is that education results in advantages that in future predisposes the person to better health outcomes (Campesi, Franconi, Seghieri & Meloni, 2017). People who are educated on various health matters are more likely to have more good health outcomes and live a more quality life as compared to those who are not educated about the health condition they may be having (Chatterjee, Davies & Khunti, 2018).

1.7 Significance of the Project

The conducting of this project will be of significant value in diabetes control and prevention strategies. Research studies have mainly dwelt on only the prevention and treatment of Type II diabetes (Antonio et al., 2018; Larkin et al., 2015). Therefore, this project aims to go a step higher, to see the impact education can have when patients are educated on why they should be compliant to their diabetic medications and why they should adhere to the lifestyle changes suggested in Type II diabetes.

The impact of this research project is that the community will be educated on the aspects of Type II diabetics. Teaching specifically on lifestyle habits to the community and its role in diabetes will be a major step in decreasing morbidity and mortality associated with Diabetes Mellitus. A community with healthy individuals will grow socially and economically. To the healthcare system, education on compliance to diabetic medications and lifestyle modifications to diabetic patients will help decrease the costs of healthcare system delivery dedicated to diabetes and reduce the resources that could have been spent on this condition (Albrecht et al., 2016; Guenette et al., 2016). These resources can be channeled to other departments including the promotion of childcare and promoting contraception services in family planning. To The patient, education will improve his well-being and he will live a longer and quality life due to the prevention of the possible complications that may have resulted of poorly managed Type II diabetes mellitus (Antonio et al., 2018).

1.8 Rationale for Methodology

The quantitative methodology type will be used in this project. This methodology will help in relating to how education on compliance and lifestyle modifications in Type II diabetic patients effectively improves their fasting blood glucose levels (Shi & Hu, 2014). The findings from this methodology will be of help in providing answers addressed in the clinical questions regarding Type II diabetes. Quantitative research methodology has the following characteristics: makes assumptions the sample chosen is a representation of the whole study population. The findings generated from this project will be generalized to a make a representation of the whole population under the study area.

Quantitative methodology is a simple and inexpensive technique for conducting a study project. Its findings are objective and not subjective. For instance, the project will focus on the role of education on medication adherence and lifestyle modifications (the Independent variables) with the outcome of improved blood glucose levels (dependent variable) in Type II diabetes mellitus.

1.9 Nature of the Project

The project will adopt a descriptive cross-sectional study design which is aimed at knowing how education on medication compliance and lifestyle modifications leads to improved fasting blood glucose levels in adults with 18 years of age above, having Type 2diabetes. This approach is selected because it is quick, economical and useful on the measuring on how education on compliance and lifestyle modifications improves blood glucose levels in diabetics. Also, no follow-ups and retrospective questions will be required.

1.10 Definition of Terms

The following terms were used operationally in this project:

Acidosis: a lot of acids in the body, as a result of the production of ketones when cells are denied of energy supply; in diabetes, the term ‘ketoacidosis’ is often used (Johnson & Marrero, 2016).

Anti-diabetic agent: An agent which helps individuals with diabetes control their blood glucose levels (Swoboda, Miller & Wills, 2017).

Fasting plasma glucose test: The FPG records an individual’s blood glucose level eight hour fasting. Normal FPG is < 100mg/dl (Asuzu, Walker, Williams & Egede, 2017).

Glucose tolerance test: a test to done if an individual has diabetes and usually done in a lab or a clinical office in the morning before an individual has ingested anything (Saslow, Summers, Aikens & Unwin, 2018).

Glycated Hemoglobin Test (HbA1C); It’s a blood test that helps determine how well a person is managing his/her diabetes (Guthrie et al., 2017).

1.11 Assumptions, Limitations and Delimitations

The following assumptions will be made during the carrying out of this project:

  1. It is assumed that the respondents who will be involved in the research process will answer correctly and truthfully to the best of their knowledge based on personal experiences on Type II diabetes.
  2. It assumed that the sample population will represent the whole population under the study
  3. It is assumed that the respondents will have positive attitudes towards the questions that will be asked and they will fully participate in the fieldwork research project.

The following are the project limitations:

  1. The unwillingness of the research subjects to respond correctly respond to the questions asked correctly for the fear of being victimized.
  2. A language barrier may lead to the misinterpretation and misreporting of the information and the wrong information analysis.
  3. Hostility to the researcher as well as the study subjects: hostility will hinder the research project making it difficult to collect information.

The following are the project delimitations:

  1. The project will not focus on screening, diagnosing or offering treatment for Type II diabetic patients due to lack of funding and equipment.
  2. No follow up of the research subjects will be done thereafter.

1.12 Summary and Organization of the Remainder of the Project

Type II diabetes mellitus is a global disease of concern, which requires an intensive approach in its management apart from only offering treatment (Semenkovich K, 2015). Therefore the development of other strategies such as education on compliance and lifestyle modifications may greatly help in improving the fasting blood glucose levels in diabetics. Patients who are educated on such aspects of diabetes are likely to have a quality life and decreased complications that are associated with diabetes (Chwastiak et al., 2017; Zaheer, 2019).

Chapter II of this research project will review the past literature concerning diabetes and its associated aspects including education on compliance and monitoring and a conceptual framework concerning diabetes. Chapter III will touch on the methodology, the research design, Sampling techniques, and Data collection. Chapter IV will provide an analysis of the data and provide a graphical representation of the results. Chapter V will conclude with the interpretation of the results and a discussion of the findings. A recommendation will be then be added regarding diabetes.

References

Abubakari, A. R., Cousins, R., Thomas, C., Sharma, D., & Naderali, E. K. (2016). Sociodemographic and clinical predictors of self-management among people with poorly controlled type 1 and type 2 diabetes: the role of illness perceptions and self-efficacy. Journal of diabetes research2016.

ADA. (2014). Diabetes Care. American Diabetes Association Standards of medical care in diabetes.

Albrecht, J. S., Park, Y., Hur, P., Huang, T. Y., Harris, I., Netzer, G., … & Moyo, P. (2016). Adherence to maintenance medications among older adults with chronic obstructive pulmonary disease. The role of depression. Annals of the American Thoracic Society13(9), 1497-1504.

Antonio, P., Zakaria, A. S., Fanchini, M., Osio, C., & Tagliabue, l. (2018). A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity. Cardiovascular Diabetology, 10.1186/s12933-018-0801-1, 17, 1.

Asuzu, C. C., Walker, R. J., Williams, J. S., & Egede, L. E. (2017). Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. Journal of Diabetes and its Complications31(1), 169-174.

Balaji, V., Seshiah, V., Ashtalakshmi, G., Ramanan, S., & Janarthinakani, M. (2014). A retrospective study on finding correlation of pioglitazone and incidences of bladder cancer in the Indian population. Indian J Endocrinol Metab, 18:425–427.

Campesi, I., Franconi, F., Seghieri, G., & Meloni, M. (2017). Sex-gender-related therapeutic approaches for cardiovascular complications associated with diabetes. Pharmacological research119, 195-207.

Chatterjee, S., Davies, M., & Khunti, K. (2018). Pharmaceutical interventions for diabetes prevention in patients at risk. American Journal of Cardiovascular Drugs18(1), 13-24.

Chwastiak, L. A., Jackson, S. L., Russo, J., DeKeyser, P., Kiefer, M., Belyeu, B., … & Lin, E. (2017). A collaborative care team to integrate behavioral health care and treatment of poorly-controlled type 2 diabetes in an urban safety net primary care clinic. General hospital psychiatry44, 10-15.

Crews, R. T., Schneider, K. L., Yalla, S. V., Reeves, N. D., & Vileikyte, L. (2016). Physiological and psychological challenges of increasing physical activity and exercise in patients at risk of diabetic foot ulcers: a critical review. Diabetes/metabolism research and reviews32(8), 791-804.

Guénette, L., Breton, M. C., Guillaumie, L., Lauzier, S., Grégoire, J. P., & Moisan, J. (2016). Psychosocial factors associated with adherence to non-insulin antidiabetes treatments. Journal of Diabetes and its Complications30(2), 335-342.

Guthrie, E. A., Afzal, C., Blakeley, C., Blakemore, A., Byford, R., Camacho, E., … & Dickens, C. (2017). CHOICE: Choosing Health Options In Chronic Care Emergencies. Programme Grants for Applied Research5(13), 1-272. Inzucchi, S., Bergenstal, R., & Buse JB, e. a. (2015). Management of hyperglycemia in type 2 diabetes: a patient-centered approach.  position statement of the American Diabetes

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