Diabetic Nursing Visits For Better A1C Control In Patients

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Literature Evaluation Table Student Name: Gregory Catania RN Change Topic (2-3 sentences): Better Diabetic A1C control in outpatient adult clinic with specialized nursing visits that include education, lifestyle changes, medications and diet. Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article 1 Article 2 Islam, S.M.S. et al. Journal of Diabetes & Metabolic Syndrome, Clinical Research & Reviews http://dx.doi.org/10.1016/j.ds x.2014.09.014 Marseglia, A. et al. Journal of Alzheimer’s Disease Vol. 53, p.1069-1078 http://dx.doi.org/10 .3233/JAD-160266 Article 3 Kuo, Y. et al. Journal of American Geriatric Society (10), 1980-1988 https://doi.org/10.111 1/jgs.13662 Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh (2014) Early Cognitive Deficits in Type 2 Diabetes A Population Based Study (2016) Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians (2015) Research Questions (Qualitative)/Hypo thesis (Quantitative), and Purposes/Aim of Study To find out the relationship of social economic factors in T2D with complications of diabetes To explore biochemical characteristics in T2D and diabetic related complications To find out diabetic related complications among Pt taking oral medications and development of complications To find out if uncontrolled diabetes has an effect on cognitive function- a predisposition to dementia To explore differences in cost of care between Nursing practitioners compared with primary care physicians Study explored eye examination, cholesterol, HbA1C, neuropathy, referrals and costs between NP and Primary physicians. The study aim: to investigate if there is a difference in cost and level of care between Nursing practitioners and primary care Study aim: To investigate the clinical features of patients with type 2 diabetes on oral medications and determine the complications and risk factors in the patients (515)Diabetic Nursing Visits For Better A1C Control In Patients.

Study Aim: To find out the effect of uncontrolled Almadhoun, M.R et al. Journal of Clinical and Experimental pharmacology 8 (3), p.1-10 DOI:10.4172/21611459.1000250 Article Title and Year Published Purpose of the study is to find out if diabetes contributes to risk of dementia (196) Article 4 © 2015. Grand Canyon University. All Rights Reserved. Assessment of Medication Adherence and its association with glycemic control among type 2 diabetes mellitus patient in Gaza (2018) To find out if medication adherence has any effect on glycemic control among T2D patients Quantitative study diabetes on the risk of dementia physicians The study was a cross-sectional quantitative study Sample size was 196 in a home for the elderly in Sweden Retrospective cohort study Cross-sectional study Evaluating data provided by Medicaid from beneficiary of primary care N=64,354 The data collected was coded and analyzed with regard to study variables T2D in Gaza attending diabetic clinic Sample size 148 Design (Type of Quantitative, or Type of Qualitative) Setting/Sample Study was a cross-sectional quantitative inquiry Methods: Intervention/Instru ments Mixed method data collected through questionnaire, face to face interview, laboratory investigations ECG, eGFR, Blood pressure machine, observation during outpatient visit The collected data was analyzed using descriptive statistics, and inferential statistics. The analysis deployed used t-test, logic analysis and simple logic regression analysis Methods included observation, laboratory tests, cognitive functions tests Analysis was done using multivariate linear regression to estimate differences and multi-nominal logistic regression to examine association Statistical Logistic regression model The study revealed that even in the best clinical setting the control of diabetes was suboptimal. Average HBA1C was 8.3; hypertension 51%, 71% had uncontrolled T2D. Uncontrolled diabetes led to eye complications (68.9%), chronic kidney disease (21.3%), CVD (11.8%) and Neurological issues (2.5) from the study subjects. There is need to have consistent screening using HBA1C goal, reduce BP and addition of statins to treatment regimens to help lower high cholesterol. The study reported that uncontrolled diabetes exposes patient to risk of dementia. There was no significant difference the two groups regarding costs except Nursing practitioners rarely performed eye examinations, there is risk of Nursing practitioners Rx wrong medications Control is diabetes is essential in reducing risks associated with diabetic complication. Diabetic control will delay cognitive problems in patient T2D Controlling diabetes help delay cognitive function impairment, nurses can help patients There is need to have a treatment protocol that investigates eyes, Hb AIC, CVD, Neurological complications to improve primary care Need to improve medical adherence to improve T2D glycemic control Nurses have a significant role in helping patient with T2D manage tighter glycemic control. The article is important because adherence to drugs leads to Analysis Key Findings Recommendations Explanation of How the Article Supports EBP/Capstone Project Sample size 515 patient at outpatient setting. The article recommends control of blood sugar as a means of reducing diabetic complications. PICOT study seeks to enhance the use of © 2017. Grand Canyon University. All Rights Reserved. Patients were followed through face to face questionnaire, laboratory examination to monitor progress Descriptive statistics and inferential statistics done. Regression analysis to determine influence of independent variables The study found out that majority of the patients did not comply with treatment instruction leading to 56.1% having poor control. HBA1C as measure of controlling T2D through education, screening and patient management in diet & lifestyle change because drugs alone are insufficient.

Criteria Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article Article 5 gain proper control through education, diet, exercise and medication Article 6 Nurses can help patient and doctors achieve targeted Hb AIC < 6.4 Article 7 better glycemic control Article 8 Ruszkowska-Giastek, B. et al. Vakili, S.T.T. et al. Wol, S.K. et al. Kostev, K. et al. Zhejiang UniversityScience (Biomedical and Biotechnology) Neurogastoral Motil, 27 (10), 1389-1397 Journal of Korean Academy of Nursing 48 92) 182-194 Journal of Diabetes, science and technology https://doi.org/10.4 040/jkan.2018.48.2 .182 https://doi.org/10 .1177/193229681 7710477 Prescription Patterns in Disease control in T2D Mellitus in Nursing home and Home care setting: Retrospective Analysis in Germany (2018) To determine the influence of treatment setting on diabetes control https://link.springer.com/c ontent/pdf/10.1631%2Fjz us.B1400218.pdf https://dx.doi.org/10. 1111%2Fnmo.12630 Article Title and Year Published Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2 (2015) Association of High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation: Evidence from the National Health and Nutrition (2015). The effects of health mentoring program in community dwelling vulnerable elderly individuals with diabetes (2018) Research Questions (Qualitative)/Hyp othesis (Quantitative), and Purposes/Aim of Study To evaluate the concentration of soluble forms of vascular adhesion in patient with controlled and uncontrolled diabetes type 2 Cross-sectional Quantitative study Hypothesis there is no relationship between diabetes and constipation. To determine the influence of mentoring in the community on health treatment outcome in T2D Design (Type of Quantitative, or Type of Qualitative) Setting/Sample The Study was a quantitative controlled randomized inquiry Examination Survey Poland sample size 62 with 35 diabetic, 27 diabetic uncontrolled and 25 healthy subjects Diabetic patients non- Hispanic 6207 subjects Methods: Intervention/Instr uments Laboratory analysis, urine, blood and kidney function tests Physical and laboratory examination, BMI, Cross –sectional study, randomized, control, quantitative design Korea setup with elderly at risk of dementia, diabetes complications 96 at the start and 70 at study end. Follow up, laboratory analysis © 2017. Grand Canyon University. All Rights Reserved. Quantitative longitudinal comparative study Germany comparing T2D in nursing homes and at home 9850 subjects /2 Analyzed, stored data between 2011 and 2015 diet water intake Analysis Statistical analysis involved test for normality, ANOVA for variance and Pearson correlation analysis to test relationship among variables Control of diabetes delays vascular impairment Descriptive Statistics and inferential statistical analysis was deployed Descriptive Statistical and inferential statistics analysis Statistical analysis using Wilcoxon tests and Chi squared test to compare analyze results There is a significant relationship between diabetic patients and constipation compared to no diabetic subjects Mentoring is an effective strategy in monitoring the diabetic patients in the community Recommendations Doctors need to ensure tight control of diabetes to prevent vascular complications and neuropathy Diet is instrumental in managing diabetes and ensuring Hb AIC targets are reached for tighter glucose control. Mentoring need to be incorporated in management of T2D in the community Explanation of How the Article Supports EBP/Capstone Control of Diabetes delays diabetic related complication including vascular impairment, CVD and heart disease The article is important because diabetic control can help reduce constipation in T2D pts The nurses are important as treatment facilitators in the community with regard to education There was no significant different between the two groups. The mean age at the nursing homes 80.7 years and those at home 74.8 years. Patients in any set up provided adequate education is offered treatment goals will be achieved. The article is vital because nurses attend to patient’s outpatient and inpatient nurses facilitate glycemic control. Key Findings © 2017 Diabetic Nursing Visits For Better A1C Control In Patients.

Grand Canyon University. All Rights Reserved. Running Head: PICOT 1 PICOT Statement on Diabetes Gregory Catania RN Grand Canyon University NRS 490 11/25/18 2 PICOT PICOT Statement on Diabetes Over the past few decades, diabetes has become a predominant health concern in the world. The prevalence of prolonged, non-communicable illnesses is increasing at a rapid rate. It is estimated that about 19 million individuals die annually due to cardiovascular illness, for which diabetes is the major underlying cause (Vakili et al., 2015). At the moment, over 1.7 billion adults worldwide are overweight and 315 million of them being obese. The number of adults with type 2 diabetes is approximated to be 250 million and it is projected to increase to 400 million by 2025 (Marseglia et al., 2016). With these statistics, it implies that a diabetes epidemic is underway. Diabetes occurs due to the impaired glucose sensitivity, whereby the blood glucose is too high. The key risk factors for diabetes include obesity and physical inactivity. Research has proved that the risk of developing diabetes can be significantly reduced by lifestyle changes (RuszkowskaGiastek et al., 2015). That said, this paper illustrates a PICOT statement on diabetes, especially on adults, and how it can be controlled. PICOT Question: An increased glucose level is independently related to an increased A1C level. Does reducing the A1C levels with specialized teaching from the nurse, practitioners, and dieticians help to control diabetes on adult patients? Population: The population for the study are American adult patients diagnosed for type 2 diabetes, aging 40 to 60 years old. This population is heterogeneous with respect to comorbidities and general health status, which is important to establishing the appropriate intervention. 3 PICOT Intervention: The intervention is quite essential as it explains on the way the researchers addressed the problem and helped the population specified for the study. Implementation of dietary and lifestyle changes would help control type 2 diabetes. Comparison: In order to determine whether the intervention is successful, A1C levels would be measured before and after the changes in lifestyle and diet. Outcome: At the end of the study, it is expected that the A1C levels of adult diabetic patients would reduce. Timeframe: The research would be conducted over a period of 12 weeks. PICOT Statement Control of type 2 diabetes for American newly diagnosed adult patients has been problematic (P) due to the poor lifestyle and diet, which leads to an increased glucose level. Specialized teaching from the nurse, practitioners, and dieticians is an effective strategy to make the patients live appropriately by eating the right food and doing exercises (I), which can enable them to control their A1C levels (C) and live the normal life (O) within 12 weeks (T). Education as regards to lifestyle modifications has been proved to be an effective intervention for controlling type 2 diabetes. Kuo et al. (2015) indicate that lifestyle interventions such as regular exercises and diet changes reduce the incidence of diabetes by 53 percent compared 4 PICOT to the control group. People assigned to these interventions reported reduced A1C levels than the control group. In a similar study by Islam, et al. (2014), changing the lifestyle plays a key role in reducing in the glucose levels, which further minimizes the cases of diabetes by 27 percent. Hence, there is an important relationship between increased glucose level and increased A1C level as well as the lifestyle change and reduced A1C levels, which leads to effective control of diabetes Diabetic Nursing Visits For Better A1C Control In Patients.

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Among patients with pre-diabetes, it is worth to control their diet and do regular exercises to help in a decrease of diabetes occurrence. Failure to prevent diabetes means increased mortality. It is, therefore, the responsibility of each person to ensure they are living a healthy life to lower the risk of diabetes. 5 PICOT References Islam, S.M.S., Alam, D.S., & Wahiduzzaman, M., Nielsen, L.W, Fresch, G., Ferrari, U, Seisoler, J, Rouf, H, M.A & Lechner, A. (2014). Clinical Characteristics and Complications of Patients with Type 2 Diabetes Attending an Urban Hospital in Bangladesh. Diabetes and Metabolic Syndrome: Clinical Research Reviews, 1-7 Kuo, Y., Goodwin, J.S. & Chen, N. Lwin, K.K., Baillargeon, J., & Raji, M.A. (2015). Diabetes Mellitus Care Providers by Nurse Practitioners versus Primary Care Physicians, Journal of American Geriatric Society. 63 (10), 1980-1988 Marseglia, A., Fratigioni, L., Laukka, E.J., Santoni, G., Pedersen, J., Backman, L. & Xu, W. (2016). Early Cognitive Deficits in Type 2 Diabetes A Population Based Study. Journal of Alzheimer Disease. 53, 1069-1078 Ruszkowska-Giastek, B., Sollup, A., Wernik, T., Rupiecht, Z., Golalczkyk, K., Gadomska, G. & Rosc, D. (2015). Effect of Uncontrolled Hyperglycemia on levels of Adhesion Molecules in Patient with Diabetic Mellitus Type 2. Zhejiang University- Science (Biomedical and Biotechnology) 16 (5), 355-361 Vakili, S.T.T., Nezami, B.G., Shetty, A., Chetty, V.K. & Srinivasan, S. (2015). Association of High Dietary Saturated Fat Intake and Uncontrolled Diabetes with Constipation: Evidence from the National Health and Nutrition Examination Survey. Neurogastoral Motil, 27 (10), 1389-1397  Diabetic Nursing Visits For Better A1C Control In Patients