Diabetes Sample Review of Related Literature

Literature Review on the Best Methods for helping DM Patients to Maintain Optimal Blood Sugar Level

 

            Diabetes mellitus is a syndrome resulting from a variable interaction of hereditary and environmental factors, and characterized by abnormal insulin secretion and a variety of metabolic and vascular manifestations reflected in a tendency toward inappropriately elevated blood glucose levels, thickened capillary basal lamina, accelerated nonspecific atherosclerosis, and neuropathy (Robbins, 1998).

            The syndrome has no distinct etiology, pathogenesis, invariable set of clinical findings, specific laboratory tests, or definitive and curative therapy, although it is nearly always associated with fasting hyperglycemia and decreased glucose tolerance.

            A relative or absolute lack of insulin secretion associated with an excess of circulating stress hormones (including glucagon, catecholamines, and cortisol) is responsible for inappropriate elevation of blood glucose and associated alterations in lipid metabolism characterizing the metabolic syndrome (Guyton & Hall, 2000).

            Diabetes mellitus increases the risk of coronary heart disease, myocardial infarction and peripheral vascular disease as well. High blood sugars are linked with accelerated development of atherosclerosis as well as high levels of serum lipids and triglycerides. Closely monitoring blood sugar levels in diabetics and checking blood sugar levels in all patients for the development of increased levels is an important nursing function. Control of blood sugar levels can greatly reduce risk and slow development of atherosclerosis (Kozier & Erb, 2004).

The primary objective in the treatment of diabetes mellitus is to achieve the patient’s optimal health and nutrition. Whether treatment of asymptomatic hyperglycemia decreases morbidity and mortality is unknown, and there is significant risk of hypoglycemia in elderly patients given oral hypoglycemic agents or insulin therapy. Therefore, it appears best not to use drug treatment for glucose intolerance in elderly patients with normal fasting plasma glucose levels or asymptomatic fasting hyperglycemia.

            Some diabetes rapidly progress with a course complicated by episodes of ketoacidosis and vascular manifestations, while others go through life with mild nonprogressing glucose intolerance and few other manifestations of the syndrome. The earliest symptom of elevated blood glucose is polyuria from the osmotic diuretic effect of glucose. Continued hyperglycemia and glucosuria may lead to thirst, hunger and weight loss.

This paper will attempt to discuss and critique five research-based journal articles that relate specifically to the chosen specific nursing topic which is about the best methods for helping diabetes mellitus (DM) patients to maintain optimal blood sugar level. A review or an analysis will be written regarding the chosen articles and a conclusion shall be formulated about the topic based on the articles reviewed.

 

Journal Article 1: A Controlled Trial of Population Management: Diabetes Mellitus: Putting Evidence into Practice.

            There are already many studies about nutrition principles and recommendations for diabetes and related complications. Long ago, this has been based on scientific evidence and diabetes knowledge when available and, when evidence was not available, on clinical experience and expert consensus.

            The particular study is about population level strategies to organize and deliver care that may improve diabetes management. The research design employed in the study is both a combination of the qualitative and quantitative approach. Measurement of cholesterol levels and blood pressure could be considered as quantitative approaches in collecting data while the use of administrative records and billing claims can fall under the qualitative approach. This is appropriate for the kind of data that is needed in the study.

Evidence-based nutrition recommendations attempt to translate research data and clinically applicable evidence into nutrition care. However, the best available evidence must still be moderated by individual circumstances and preferences. The goal of evidence-based recommendations is to improve the quality of clinical judgments and facilitate cost-effective care by increasing the awareness of clinicians and patients with diabetes of the evidence supporting nutrition services and the strength of that evidence, both in quality and quantity (Wheeler, 2002).

            The current nutrition principles and recommendations for diabetes focus on lifestyle goals and strategies for the treatment of diabetes. Whether for management or prevention of diabetes and its complications, basic to the nutrition recommendations is the underlying concern for optimal nutrition through healthy food choices and an active lifestyle.

            Population-level clinical registries combined with summarized recommendations had a modest effect on management. The intervention was limited by good overall quality of care at baseline and temporal improvements in all control clinics, it is unknown whether this intervention would have had greater impact in clinical settings with lower overall quality.

Overall, the study can be used to further educate health care practitioners in helping DM patients. Further research into more effective methods of translating population registry information into action is still required though.

 

Journal Article 2: A Revitalized Battle Against Diabetes Mellitus for the New Millennium.

            Diabetes mellitus, one of the world’s most serious health problems and most prevalent diseases, has been a major cause of morbidity worldwide. Nurses are continuously employing new research findings and aggressive strategies to help overcome the disease. A significant population has one or more risk factors for developing diabetes.

            This particular study aims to inform and educate health care professionals, most especially the nurses in the control and treatment of DM. Managing diabetes successfully is a lifelong commitment, which emphasizes continual education and management adjustments as health status and conditions change. Components of the diabetes management plan include: medical nutrition therapy, physical activity, blood glucose monitoring, diabetes medications (if needed), behavioral strategies to promote lifestyle changes, and education regarding how to integrate the above components and related healthy habits.

            This particular study is basically an evidence and research based paper which discusses the various control and treatment strategies for DM patients. Nursing care strategies are being discussed more specifically. Aside from that, the role of the DM patient in learning about how to overcome the disease is also emphasized.

            This particular paper could help health care professionals and DM patients alike in being more aware of the proper control and treatment measures for the disease. This could be a good source of education for both the health care professionals and the DM patients alike.

            The study concluded that more aggressive approaches to diagnose and treat diabetes are now a critical goal for health care providers. The number of treatment modalities for diabetes is increasing as researchers develop more new oral anti-diabetic agents. Nursing care needs to be "in sync" with this new proactive stance against diabetes. Nurses in acute care will be using new drug combinations to treat patients with diabetes. Nurses in all settings must understand the significance of glycemic control. The health care system is declaring war on diabetes, one of the oldest diseases known to man. Nurses are on the front line armed with new strategies for the new millennium.

 

Journal Article 3: Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care.

            This particular study assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness. One study has concluded that that the initial occurrence of clinically significant depression, major depressive disorder (MDD), results from either biochemical changes directly due to type 2 diabetes or its treatment or from the psychosocial demands imposed by the illness or its treatment do not seem to be supported. MDD in diabetic individuals represents a multi-determined phenomenon resulting from interactions between biologic and psychosocial factors. This interaction may increase the probability of developing type II diabetes in otherwise healthy individuals (Nouwen, 2000).

            Empirical studies strongly suggest that depression is more prevalent among adults with diabetes than among the general population. To date, the reasons for the higher prevalence rates of depression in diabetic patients are not yet fully understood. The two dominant hypotheses concerning the initial occurrence or recurrence of clinically significant depression in individuals with diabetes are as follows: 1) it results from biochemical changes directly due to the illness or its treatment and 2) it results from the psychosocial demands or psychological factors related to the illness or its treatment (Nouwen, 2000).

            In this study, the research design and methods used are of the qualitative approach. In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services. This is suitable for the kind of data that the research needs.

            The results of the study showed that in a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.

            In particular, diabetic patients with depression need support for self-management activities such as lifestyle modifications and medication adherence, this study can somehow help health care practitioners in how to provide appropriate services that can help DM patients. Further research is needed to evaluate whether integrating depression screening and treatment into comprehensive care of diabetes could enhance self-management, adherence, and patient outcomes.

 

Journal Article 4: Increasing Incidence of Diabetes After Gestational Diabetes: A Long Term Follow-Up in a Danish Population.

            The objective of this research was to study the incidence of diabetes among women with previous diet-treated gestational diabetes mellitus (GDM) in the light of the general increasing incidence of overweight and diabetes and to identify risk factors for the development of diabetes.

            Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies regardless of whether treatment includes diet modification alone or in combination with insulin. It does not exclude the possibility that unrecognized glucose intolerance may have antedated or begun concomitantly with the pregnancy (Gabbe, 1998).

            Maternal morbidity due to GDM may be immediate or long-term. Many studies have documented an increase in preeclampsia, polyhydramnios, and operative delivery in pregnancies complicated by GDM. Infants of mothers with GDM (IGDM) are not at increased risk for congenital anomalies unless these women have preexisting diabetes mellitus. However, IGDM do have an increased risk of perinatal mortality and morbidity, including hyperbilirubinemia, macrosomia and birth trauma, and hypoglycernia (Gabbe, 1998).

            In the research design and method, women with diet-treated GDM during 1978-1985 (old cohort, n = 241, also followed up around 1990) or 1087-1996 (new cohort, n = 512) were examined in 2000-2002. Women were classified by a 2-h, 75-g oral glucose tolerance test according to the World Health Organization criteria or an intravenous glucagon test supplemented by measurement of GAD antibodies. Historical data from index-pregnancy and anthropometrical measurements were collected. This is a qualitative form of research and is suitable for this type of data.

            The results of the study showed that the incidence of diabetes among Danish women with previous diet-treated GDM was very high and had more than doubled over a 10-year period. This seems to be due to a substantial increase in body mass index (BMI) in women with GDM. The study supports previous findings that women with GDM are at high risk for subsequent diabetes. The risk is further increased if obesity is present before pregnancy. The importance of this study is that this could provide further information for health care professionals in helping women with GDM.

 

Journal Article 5: How Well Do Patient’s Assessments of Their Diabetes Self-Management Correlate with Actual Glycemic Control and Receipt of Recommended Diabetes Services?

            Although patient diabetes self-management is a key determinant of health outcomes, there is little evidence on whether patients' own assessments of their self-management correlates with glycemic control and key aspects of high-quality diabetes care. Because of this, there is a need for further research on this area, and that is why this study was conducted.

            For this study, the researchers abstracted information on achieved level of glycemic control and diabetes processes of care from medical records of 1,032 diabetic patients who received care from 21 VA facilities and had answered the Diabetes Quality Improvement Program survey in 2000. The survey included sociodemographic measures and a five-item scale assessing the patients' diabetes self-management (medication use, blood glucose monitoring, diet, exercise, and foot care).

Using multivariable regression, the researchers examined the associations of patients' reported self-management with glycosylated hemoglobin [HbA_1c] level and receipt of each diabetes process of care. The researchers then adjusted for diabetes severity and comorbidities, insulin use, age, ethnicity, income, education, use of VA services, and clustering at the facility level.

The study used the qualitative method of research and employed statistical computations to come up with the needed data. There was further explanation in the paper on the overall strategy of how the researchers came up with the data.

            The results showed that higher patient evaluations of their diabetes self-management were significantly associated with lower HbA_1c levels and receipt of diabetes services. Those in the 95th percentile for self-management had a mean HbA_1c level of 7.3, whereas those in the 5th percentile had mean levels of 8.3. For every 10-point increase in patients' ratings of their diabetes self-management, even after adjusting for number of outpatient visits, the odds of receiving an HbA_1c test in the past year increased by 15%, of receiving an eye examination increased by 16% (7-27%), and of receiving a nephropathy screen increased by 13%.

            Measurement of HbA_1c thus provides information useful for the management of DM. Since the mean half life of an erythrocyte is 60 days, the HbA_1c level reflects the average blood glucose concentration over the preceding 6-8 weeks. And elevated HbA_1c, which indicates poor control of blood glucose level, can guide health care professionals in the selection of appropriate treatment – more rigorous control of diet or increased insulin dosage (Murray, et al, 2000).

            The findings of this study were useful in reinforcing the usefulness of patient evaluations of their own self-management for understanding and improving glycemic control. The mechanisms by which those patients who are more actively engaged in their diabetes self-care are also more likely to receive necessary services warrant further study.

 

Conclusion

            Diabetes mellitus is a syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin. The basic effect of this lack in insulin is the increase in blood glucose concentration.

            In the journals discussed, there are several methods for helping DM patients maintain optimal blood sugar levels. This includes administering enough insulin so that the patient will have metabolism that is as normal as possible. Dieting and exercise are also recommended in an attempt to induce weight loss and to reverse insulin resistance. If these methods fail, drugs may be administered to increase insulin sensitivity or to stimulate increased insulin production.

 

 

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