Population Health Research and PICOT Statement

The incidence of type 2DM is relatively high globally. The number of individuals diagnosed with this condition worldwide has quadrupled in the past three decades. Approximately 1 in every 11 adults globally is diagnosed with diabetes mellitus. About 90% of diabetic individuals have type 2 diabetes mellitus (T2DM) (Zheng et al., 2020). Consequently, diabetes mellitus has been ranked as the ninth major cause of death globally. In the year 2011, there were 366 million people with diabetes. This figure is expected to increase globally to 52 million by the year 2030. In the same year, diabetes was the major cause of close to 4.6 million deaths, which accounted for 11% of the USA health expenditure (Janapala et al., 2019). The gradual increase in the incidences of both Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) increases the short-term and long-term complications of DM as the most significant public health issue currently. Its complications range from ketoacidosis and hypoglycemia to nephropathy, retinopathy, neuropathy, and cardiovascular illnesses (Papatheodorou et al. 2018).Population Health Research and PICOT Statement

In the US, approximately 26 million people have diabetes mellitus (DM), yet 7 million are unaware. The prevalence of diabetes in the US continues to increase from five to seven-fold. In the year 2010, there were 1.9 million new DM cases diagnosed among adults.  The World Health Organization (WHO) further estimates that Americans’ lifetime risk in 2000 is 30% among males and 40% among females (Laffel et al., 2020). Diabetes is the major cause of cardiovascular disease, blindness, premature death, renal failure, and a decreased quality of life. Apart from having short-term and long-term complications, diabetes also has economic implications since it costs the federal government of the US approximately $174 billion annually and increases the burden on healthcare resources and systems. Therefore, this paper focuses on proposing measures for controlling glycemic levels among adults with T2D.

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Article Selection Criteria

Various criteria were utilized during the article search. The first selection criterion was the year of publication. Articles that were published in the past two years were selected for the study. Additionally, articles were selected based on key terms, which were defined in the PICOT question. These terms include diabetes type Mellitus, Continuous Blood Glucose Monitoring, Self-Blood glucose monitoring, and glycemic control. Finally, the selected articles must be peer-reviewed and accessible from the GCU Library.

Literature Synthesize: Part A

A study conducted by Mangrola et al. (2018) focused on assessing the differences in glucose values reported when SBGM was utilized to manage T2D versus those recorded by continuous glucose monitoring (CGM). A clinical diabetes educator (CDE) used the Medtronic iPRO2™ system to conduct CGM during the study. Additionally, 67 patients, 27 and 34 with T1DM and T2DM, managed their conditions through SBGM without any change during the four days of study. Study findings indicated that 25 mg/dL glucose levels were the lowest values reported by SBGM in T1DM and T2DM. A correlation was reported between HgBA1c and the highest and average glucose levels by both methods. The researcher recorded the lowest glucose values before breakfast and during sleep. On the contrary, the highest values were reported in postprandially and evening. This study does not support the PICOT since it indicates that SBGM compared to CGM, effectively regulates glycemic levels in individuals with T2D.

Another study was conducted by Yeoh et al. (2018) to compare glycemic control and hypoglycemia incidence in individuals diagnosed with Stage 3 DKD who were receiving retrospective CGM-guided anti-diabetic therapy compared to those under SMBG in 3 months. Thirty patients whose level of HbA1c was greater than 8% were randomized to either retrospective SMBG or CGM that lasted for six days. Patients wore CGM at the beginning and six weeks. The researcher assessed hypoglycemia events and adjusted the medication at the baseline and after three months. All patients were educated on how to avoid hypoglycemia. Study findings revealed that CGM’s short-term use lowered the duration spent in the hyperglycemia range without raising the patients’ exposure to hypoglycemia. Nonetheless, SMBG and CGM were equally effective in boosting glycaemic control. This study does not support the PICOT since it indicated that SMBG and CGM were equally effective in boosting glycaemic control.Population Health Research and PICOT Statement

Furthermore, Zheng et al. (2020) conducted a study focused on comparing multiple forms of CGM systems versus SMBG in managing diabetes amongst adults diagnosed with T2D. Various databases, including Cochrane Library, PubMed, EMBASE, CINAHL, and PsycINFO, were searched for the required literature. Study findings indicated that CGM interventions are effective in controlling T2D among adults. This study supports the PICO since it indicates that CGM, compared to SMBG, effectively controls glycemic levels among adult patients diagnosed with type 2DM.

Taylor et al. (2019) conducted a pilot study to evaluate the acceptability and tolerability levels of real-time CGM and its effect on managing the behaviors of individuals diagnosed with Type 2 Diabetes. Twenty adults included ten men, and ten women who were diagnosed with T2D participated in the study. The participants were randomized to a low-carbohydrate lifestyle while wearing an RT-CGM diabetes monitoring system for 12 weeks continuously. The study outcomes included glycaemic control (HbA1c), CGM device intolerance, weight (kg) perceived stress scale (PSS), acceptability, diabetes management, and motivation to change. Study findings revealed a significant reduction in body weight in both groups. Therefore, both CGM and SMBG are effective in managing glucose in individuals with T2D. This study does not support the PICO question since it indicated that CGM and SMBG are equally effective in controlling glycemic levels among adult patients diagnosed with type 2DM.

Finally, a study was conducted by Ohara et al. (2019) to assess the clinical factors that have an impact on day-to-day glucose variability using CGM. The researchers conducted a cross-sectional analysis of individuals diagnosed with type 2 diabetes mellitus (T2DM). The selected individuals had undergone a glucagon stimulation test with 72 h of CGM. They evaluated the daily glucose variability of the selected patients using CGM. Study findings indicated a correlation between CPR with the stability of glycemic control. Additionally, poorly controlled diabetes is attributed to a rise in glucose variability. This study does not support the PICO question since it does not compare the effectiveness of CGM and SMBG in controlling glycemic levels among adult patients diagnosed with type 2DM.

Part B: Comparison of the Selected Studies

The selected articles have similarities and differences.

Similarities

All the studies focused on adults diagnosed with T2D. The researchers focused on assessing the effectiveness of CGM and SMBG in controlling glycemic levels among adult patients diagnosed with type 2DM in their studies.Population Health Research and PICOT Statement

Differences

Some studies indicate that one intervention was effective than the other in controlling the glycemic level. A study by Zheng et al. (2020) indicated that CGM intervention is effective compared to SMBG in controlling T2D among adults. Therefore, this study supported the PICO question. A study by Mangrola et al. (2018) revealed that SBGM compared to CGM is effectiveness in regulating glycemic levels in individuals with T2D. On the contrary, some studies indicated that SMBG and CGM were equally effective in boosting glycaemic control among adults with T2D. A study by Yeoh et al. (2018) revealed that SMBG and CGM were equally effective in boosting glycaemic control. Similarly, a study by Tylor et al. (2019) indicated that CGM and SMBG are equally effective in controlling glycemic levels among adult patients diagnosed with type 2DM.

Further Studies

The selected articles indicate gaps that need to be studied further. First, researchers need to study the effectiveness of Continuous Blood Glucose Monitoring compared to Self-Blood glucose monitoring (SBGM) in controlling glycemic levels among other patient populations other than adults. Studying this gap will reveal which intervention is effective among the selected patient population. Additionally, studies need to be conducted to evaluate the effectiveness of Continuous Blood Glucose Monitoring compared to Self-Blood glucose monitoring (SBGM) in controlling glycemic levels among adult patients with T1D. Finally, a study can be conducted to assess other interventions that can be implemented to control glycemic levels other than SBGM and CGM.

References

Janapala, R. N., Jayaraj, J. S., Fathima, N., Kashif, T., Usman, N., Dasari, A., Jahan, N., & Sachmechi, I. (2019). Continuous Glucose Monitoring Versus Self-monitoring of Blood Glucose in Type 2 Diabetes Mellitus: A Systematic Review with Meta-analysis. Cureus, 11(9), e5634. https://doi.org/10.7759/cureus.5634

Laffel, K, BeckBergamo, K., Clements, M. A., Criego, A.  & Messer, L. H. (2020). Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. Jama, 323(23), 2388-2396.

Mangrola, D., Cox, C., Furman, A. S., Krishnan, S., & Karakas, S. E. (2018). Self-blood glucose monitoring underestimates hyperglycemia and hypoglycemia as compared to continuous glucose monitoring in type 1 and type 2 diabetes. Endocrine Practice, 24(1), 47-52.

Ohara, M., Hiromura, M., Nagaike, H., Kohata, Y., Fujikawa, T., Goto, S., … & Mori, Y. (2019). Relationship between glucose variability evaluated by continuous glucose monitoring and clinical factors, including glucagon-stimulated insulin secretion in patients with type 2 diabetes. Diabetes Research and Clinical Practice, 158, 107904.

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of diabetes research, 2018, 3086167. https://doi.org/10.1155/2018/3086167

Taylor, P. J., Thompson, C. H., Luscombe-Marsh, N. D., Wycherley, T. P., Wittert, G., Brinkworth, G. D., & Zajac, I. (2019). Tolerability and acceptability of real-time continuous glucose monitoring and its impact on diabetes management behaviours in individuals with Type 2 Diabetes–A pilot study. Diabetes research and clinical practice, 155, 107814. Population Health Research and PICOT Statement