PICOT Question and Literature Search

Posted: January 5th, 2023

PICOT Question and Literature Search

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PICOT Question and Literature Search

Society should emphasize the most suitable approaches to addressing diabetes that can cause significant harm to individual health and institution as a whole. Diabetes, according to DeJesus et al. (2018), is a risk factor for untimely sickness and death, chiefly due to heart disease, but can also cause other complications, which make it universal public health concern. The International Diabetes Federation acknowledges diabetes as a severe concern stating that prevalence among people between 21 and 80 years old hit 8.4% in 2014, with 77% of the global incidences emerging from low and middle-income economies (Galaviz, Narayan, Lobelo & Weber 2018). The paper recommends enhancing education and awareness on the need to participate in regular physical exercises and maintain a healthy diet as suitable ways to prevent and manage the condition. Interveners (educators) need to recommend a proper physical exercise plan and create a guideline to control how one eats to help affected individuals lead a healthy and longer life.   

Summary of Clinical Issue

Diabetes type 2 is a significant challenge in the U.S. and other parts of the globe. Galaviz, Narayan, Lobelo, and Weber (2018) inform that diabetes is an expensive ailment affecting more than 385 million people worldwide and at least 27.5 million individuals in the United States. Galaviz, Narayan, Lobelo, and Weber (2018) further state that the precursor of diabetes, prediabetes, affects nearly 315 and 85.8 million people worldwide and in the U.S., respectively. Prediabetes, according to Galaviz, Narayan, Lobelo, and Weber (2018), is a condition of hyperglycemia where sugar levels are beyond than recommended rates but considerably lower than the thresholds amounting to diabetes and encompasses both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). IFG is described as fasting plasma glucose (FPG) reaching 101 to 124 milligrams per deciliter (mg/dL). More specifically, Galaviz, Narayan, Lobelo, and Weber (2018) attribute increased blood sugar levels to deficiencies in insulin action or secretion or as a result of both defects, where IFG depicts an affected role of β-cell and impaired glucose tolerance or insulin resistance. HbA1c (glycated haemoglobin) is a sign of severe hyperglycemia, and rates between 5.6% and 6.5% are also clinically utilized to determine prediabetes. A suitable way for diagnosing impaired glucose tolerance, on the other hand, happens after plasma glucose levels hit 141 to 198 mg/dL after conducting an oral glucose tolerance test. Galaviz, Narayan, Lobelo, and Weber (2018) further reveal that the ailment and its precursor affect about 8 and 7 percent of the entire globe’s population, respectively. Galaviz, Narayan, Lobelo, and Weber (2018) show how individuals living with increased blood sugar levels are at considerable threat for mortality and may quickly develop a wide range of cardiometabolic illnesses. Type 2 diabetes constitutes the most significant case (94%) of all diabetes cases. It is why the ailment is a leading contributor to morbidity and cardiovascular mortality across the globe (Galaviz, Narayan, Lobelo & Weber 2018). Those who have diabetes type 2 require effective intervention to achieve the appropriate results that guarantee stable health as non-affected individuals. 

It is imperative to identify and stick with the best intervention because diabetes presents a severe financial burden to societies and individuals. Galaviz, Narayan, Lobelo, and Weber (2018) inform that the worldwide health spending on diabetes hit $611.9 billion in 2014. The researchers further declare that the U.S. has the expenditure on diabetes globally and give an example of 2012 when the ailment cost the country at least $244 billion, with more than $175 billion used in direct medical expenditure and $70 billion invested in combating productivity rate (Galaviz, Narayan, Lobelo & Weber 2018). The value of undiagnosed cases alone is projected to be beyond $32 billion, indicating that direct and indirect costs of handling the condition may not be identified correctly (Galaviz, Narayan, Lobelo & Weber 2018). Overall, American citizens with diagnosed type 2 diabetes have about 2.5 times elevated medical bill than non-affected individual, creating a financial constraint that affects societies, households, and individuals through increased insurance premiums and levies, the depreciated standard of living, and dropped earnings (Galaviz, Narayan, Lobelo & Weber 2018). Consequently, it is vital to identify the most suitable intervention to suit the group and proceed with practical implementation.

PICOT Question

For adult clients at high risk for type 2 diabetes in the hospital environment (P), will the utilization of a initiative for pre-diabetes teaching on workout and diet for lifestyle changes (I), related to present practices (C), advance the level of, diet, exercise, sand weight, dropping the advancement of type 2 diabetes (O), when assessed once-a-month for a period of three months (T)?

Relationship of Articles to the PICOT Question – Literature Review

Evidence confirms that constant physical activities are a reputable approach to managing type 2 diabetes. Reynolds, Moodie, Venn, and Mann (2020) demonstrate that regular physical activities enhance cardio-metabolic health and further inform that taking a walk after a meal lowers postprandial glycaemia, which happens when the blood glucose level is considerably high. The condition occurs when the amount of insulin in the body is not enough or cannot effectively use the hormone that transports glucose into the blood. Further evidence by Reynolds, Moodie, Venn, and Mann (2020) show how a prescription to walk every day enhanced self-reported time used walking in people with type 2 diabetes. Thus, it is indispensable to shape consistent observation, vigorous family support, and constant procedures by health care specialists to stimulate obedience to physical excercises. Reynolds, Moodie, Venn, and Mann (2020) find that although a prescription to take part in physical activities offered in primary care has shown encouraging outcome as an adjunct intervention for people with the condition, there is considerably inadequate awareness regarding determinants of adherence with physical practices for people living with type 2 diabetes. Therefore, it is essential to overcome the barriers and challenges deterring affected individuals from participating in a gym or class-based exercise. A 2014 study conducted by Reynolds, Moodie, Venn, and Mann (2020) reveal that various determinants such as ethnicity, duration of the condition, systolic blood pressure (mmHg), lifestyle, and HbA1c or how one’s blood glucose has behaved over three months are crucial factors that either promote or derail how one participates in physical activities. Unless those who have diabetes type 2 increase their urge to participate in physical practices, regulating the condition may be futile.

It is upon health and non-health educators to inform affected individuals and the public about the need to participate in physical exercises and how the practice helps address the condition most effectively. Borek et al. (2019) support diabetes type 2 education and self-management training arguing that the approach serves a crucial function in managing the disease. Educators, for example, should inform members of the public that physical exercise or activity entails all activities or movements that elevate energy use. The process should tell that physical activities enhance blood sugar control in patients living with type 2 diabetes and have other benefits, including minimizing the risk factors for cardiovascular, contributing to a decrease in weight, and elevates wellbeing (Reynolds, Moodie, Venn & Mann 2020). The education and awareness process should notify the affected persons and the public that physical practices make the body more responsive to the hormone that permits body cells to utilize blood glucose for energy, which play critical functions in managing diabetes (Borek et al. 2019). A fundamental aspect of the awareness process is to inform the target population about the various ways of exercising to achieve one’s fitness objectives. Affected individuals and the public should understand through the education process that they do not need to register with a gym or purchase costly equipment to exercise effectively. Still, instead, they can engage in walking (Borek et al., 2019). Other practices that people should know and which can effectively help to manage type 2 diabetes include cycling, swimming, team sports, weightlifting, resistance band practices, and callisthenics, among others (Borek et al., 2019). Nevertheless, the attempts to encourage people to participate in physical exercise to mitigate type 2 diabetes may not yield fruitful outcome without paying considerable attention to how the process may excel.

In addition to informing diabetic patients about the need to participate in regular physical exercises, interveners should emphasize the need to watch one’s diet when living with the condition. Various scholars affirm that maintaining a desirable diet offers a better chance for type 2 diabetes patients to manage the condition quite effectively. Galaviz, Narayan, Lobelo, and Weber (2018), for instance, recommend that diabetic people be referred to intensive diet programs aimed at minimizing weight. The authors also find it appropriate to offer valuable information about a healthy diet for affected persons in support and self-management educational initiatives. It is also essential to conduct a follow-up while proceeding with counselling and education to help individuals make wise decisions and sustain lifestyle adjustments (Gebreyesus et al. 2021). The teaching and awareness processes should emphasize fish, leafy greens, avocados, eggs, beans, and nuts that Abouammoh, Barnes, and Goyder (2016) identify as suitable for individuals living with both diabetes type 1 and type 2. Even though the American Diabetes Association does not strictly forbid people with type 2 diabetes from eating sugary foods such as chocolate, ice cream, sugary tea, and sweets, it recommends doing so in regulation and awareness of how it could increase one’s blood glucose. Type 2 diabetics can still consume sugary foods as long as they observe a healthy diet and participate in physical exercises (Abouammoh, Barnes & Goyder 2016). The awareness process is more likely to impact affected individuals if it helps them understand that the sugar intake should not go beyond the recommended 2500 calories each day for men and 2000 for women (Abouammoh, Barnes & Goyder 2016). Thus, an appropriate way to improve the wellbeing of type 2 diabetics is to educate them on suitable dietary plan. 

Emphasizing enough physical exercise and proper diet are essential in managing diabetes type 2 because both initiatives play fundamental functions in lowering energy balance, resulting in diabetes. Galaviz, Narayan, Lobelo, and Weber (2018) write that energy balance serves an essential role in diabetes type 2. Galaviz, Narayan, Lobelo, and Weber (2018) identify the primary components in the energy balance equation as falling into two essential categories; energy expenditure and energy consumption. The latter directly connects to an appropriate diet. The former has a direct connection to physical exercise. Galaviz, Narayan, Lobelo, and Weber (2018) further argue that heightened levels of high energy intake have been identified to enhance the risk of diabetes by 12% to 25%, whereas enough levels of physical exercise lower risk by 7% to 29%. Galaviz, Narayan, Lobelo, and Weber (2018) also assert that a positive energy balance where the intake of energy is higher than energy use could result in being overweight that could cause one to be obese, heightening the risk for diabetes type 2. Lack of physical exercise and obesity can result in insulin resistance by elevating the nonphysiological placement of fat in muscle and visceral tissues and intracellular suppressing glucose transporter-4 in specific muscles (Galaviz, Narayan, Lobelo & Weber 2018).Several other factors prompt individuals, especially those who live with type 2 diabetes to engage in regular physical exercises and watch how they eat if they want to stay heathy.

One must engage in activities that would prevent them from accumulating much fat because this could be a threat causing insulin resistance (West et al. 2020). Therefore, continuous awareness of the need to take part in physical exercises and maintain a healthy diet to avoid developing visceral fat, especially intrahepatic fat related to insulin resistance and accumulation of lipids in muscle cells (West et al. 2020). It is proper to maintain a lifestyle that prevents further collection of unwanted adipose tissue that disrupts the signaling that controls the transportation of glucose, chiefly by sending disruptive communication like oxidative stress, cytokines, and fatty acids, which tampers with insulin’s capability to control the production of glucose by the liver and consumption by the muscle (Galaviz, Narayan, Lobelo & Weber 2018). Thus, relentless education and awareness are needed to help individuals living with diabetes type 2 lead a life that is not likely to encounter sudden health complications.  

Method

Reynolds, Moodie, Venn, and Mann (2020) conduct qualitative research to identify the hurdles and facilitators encountered by adults with type 2 diabetes when recommended that they engage in regular physical exercises. Participants were asked to embrace a standard walking plan that fulfilled present guidelines on physical activities for type 2 diabetes for three months. The questions issued before and after the intervention focused on respondents’ participation rate in physical exercises and self-related health. A reputable institution in New Zealand approved te study and issued the go ahead. Thematic examination of recorded interviews conducted after three months of prescribing physical exercise showed significant hindrances and promoters to adherence for participants. To achieve the present weekly physical exercise framework, participating individuals were directed to walk for approximately ten minutes after all three meals every day for three months. However, the study neither mentions how long one can walk after ten minutes nor specify the walking intensity. More fundamentally, participants were asked not to alter their lifestyle behaviours and diet other than adhering to the walking directive. Researchers contacted participants after every fortnight for three months to remind them of the prescription.

Sample

Twenty-eight participants aged 18 to 75 years and classified as living with type 2 diabetes were encouraged to take part in the research immediately after taking part in a randomized crossover study. The participants were acquired through various approaches, including assessing those who have diabetes type 2 and those who do not. Living with the condition was a major determining factor for taking part in the exercise. Availability of comorbidities did not restrain participants from taking part in the exercise. A hormone specialist examined participants during the research, although this did not prevent them from participating in the sessions with their healthcare worker. All participants submitted a written informed consent before taking part in the exercise.

Key Findings

The study identified several facilitators and barriers determining how participants engage in regular walking exercise. Some of the facilitators that Reynolds, Moodie, Venn, and Mann (2020) identify from the research include the level of reinforcement, the individual’s perception of the routine as essential or not essential, and family influence. Reynolds, Moodie, Venn, and Mann (2020) find that those who received adequate social support spent more time walking than those who lacked the support. Some of the barriers that deter some participants from taking part in prescribed walk include competing routines, discomfort with the exercise, lack of time in the evenings, and unfavorable weather condition. The study also showed that those who maintained poor eating habits did not record fast and steady improvement as their counterparts keenly monitored their diet considering their health status.

Recommendations of the Researchers

Although physical exercise is already an established form of managing diabetes type 2, and health practitioners are already urging their clients to be active in the way they engage in such practices, there is a need to address the variations in adhering to prescriptions. Reynolds, Moodie, Venn, and Mann (2020) share the same view with Kriska et al. (2020) that educators can play critical roles in achieving adherence by informing about the benefits of participating in such activities. Educators can encourage affected individuals by telling them that a well-planned walking prescription can enhance self-reported time used in walking. Besides, Reynolds, Moodie, Venn, and Mann (2020) recommend the need to alternate physical exercises with a proper diet to achieve the best results.

Conclusion

The report pays attention to the possibilities of addressing type 2 diabetes by enhancing an education plan that emphasizes a good diet and regular physical exercise. The study reveals how constant exercises and proper diet improve insulin release and use that determine how the body transports the hormone via the blood. One does not have to use a lot of money to develop an effective training plan because simple activities such as walking, cycling, and other forms of movements could go a long way toward preventing and managing type 2 diabetes. The awareness process should pay considerable attention to sensitizing affected people about the right foods to consume regularly to avoid adding fat that could cause obesity. Type 2 diabetics learn the importance of not taking sugary foods regularly because this could enhance their blood glucose level. The findings of a qualitative study reveal that physical exercises play essential functions in managing diabetes type 2 and further shows that one achieves better results by combining with proper diet.

References

Abouammoh, N., Barnes, S., & Goyder, E. (2016). Providing lifestyle advice to people with type 2 diabetes from different cultures: A qualitative investigation. Diabetes & Primary Care 18 (6), 283-287. https://www.diabetesonthenet.com/uploads/resources/dotn/_master/4839/files/pdf/dpc18-6-283-7.pdf

Borek, A., et al. (2019). ‘We’re all in the same boat’: A qualitative study on how groups work in a diabetes prevention and management programme. British Journal of Health Psychology 24, 787-805. doi:10.1111/bjhp.12379

DeJesus, R., et al. (2018). Impact of a 12-week wellness coaching on self-care behaviors among primary care adult patients with prediabetes. Preventive Medicine Reports 10, 100-105. https://doi.org/10.1016/j.pmedr.2018.02.012

Galaviz, K., Narayan, V., Lobelo, F., & Weber, M. (2018). Lifestyle and the prevention of type 2 diabetes: A status report. American Journal of Lifestyle Medicine, 4-20. doi: 10.1177/1559827615619159

Gebreyesus, H. A., Abreha, G. F., Besherae, S. D., Abera, M. A., Weldegerima, A. H., Kidane, E. G., Bezabih, A. M., Lemma, T. B., & Nigatu, T. G. (2021). Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: A cross-sectional study. BMC Endocrine Disorders 21 (1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s12902-021-00750-5

Kriska, A., et al. (2020). The impact of physical activity on the prevention of type 2 diabetes: Evidence and lessons learned from the diabetes prevention program, a long-standing clinical trial incorporating subjective and objective activity measures. Diabetes Care, 1-7. https://doi.org/10.2337/dc20-1129

Reynolds, A., Moodie, I., Venn, B., & Mann, J. (2020). How do we support walking prescriptions for type 2 diabetes management? Facilitators and barriers following a 3-month prescription. Journal of Primary Health Care, 12 (2), 173-180. doi: 10.1071/HC20023

West, A. B., Konopka, A. R., LeBreton, K. A., Miller, B. F., Hamilton, K. L., & Leach, H. J. (2020). Incorporating behavior change strategies into an exercise trial to improve physical activity maintenance among adults at high risk for type II diabetes. Journal of Aging & Physical Activity, 28 (6), 813–821. https://doi-org.lopes.idm.oclc.org/10.1123/japa.2019-0307