How to write a research paper on Type II Diabetes

How to write a research paper on Type II Diabetes

Type 2 diabetes is the most common metabolic disorder worldwide and its prevalence is growing at an alarming rate. Rapid economic development and urbanization have led to the increased burden of the disease in many countries. Diabetes affects an individual’s functional capacity and quality of life with adverse outcomes like mortality and morbidity increasing annually across all populations (Muegge & Tobin, 2016). To address the challenge of this disease and to reduce acute complications, healthcare providers have focused on continuing medical care, patient self-management, and follow-up strategies. Despite the availability of these strategies, adherence to medication is a challenge for many patients leading to poor glycemic control and the development of other complications (American Diabetes Association, 2020). To address this challenge, strategies like the use of computerized reminder systems and follow-up using the telephone on office visits can greatly improve adherence to treatment.

Adherence to diabetes medication is an area that has raised concerns recently due to the increasing rate of type 2 diabetes in many countries. The set of factors associated with medication adherence is very broad leaving institutions with gaps in promoting control of the disease. For instance, the stress of living with the disease, lack of adequate education, cognitive impairment, and the burden of the disease among the elderly contribute to poor adherence to medication (Jimenez et al., 2020). This project focuses on how primary care providers can improve adherence to diabetes treatment using the most basic and affordable approaches. With the increased use of technology in healthcare today, routine telephone calls and the use of computerized reminder systems can serve to promote the management of the disease rather than depending on the patient’s individual judgment to seek initial and subsequent treatments.

Overview of the Problem

Type 2 diabetes is a serious public health problem with a considerable impact on human life and healthcare expenditure. The disease is among the top five chronic illnesses including heart disease, cancer, stroke, and chronic obstructive pulmonary disease (COPD) which cause more than two-thirds of all deaths in the US. The increasing trend of the disease in the country is caused by the consumption of unhealthy diets and sedentary lifestyles (Doherty, 2020). The result is increased body mass index (BMI) and fasting plasma glucose that results in diabetes. The aging of individuals is another reason why the rate of diabetes has increased over the years. According to recent reports, more than 34 million Americans have diabetes that translates to about 1 in 10 people (Centers for Disease Control and Prevention (CDC), 2020). Lack of adherence to medication and self-care recommendations causes more harm to the affected individuals because of the observed poor glycemic control. The result is increased cost of hospitalization, morbidity, and mortality rates among the affected individuals.

Unlike many health conditions, diabetes management is mostly done by the affected individual with support from the healthcare team. The problem of medication adherence is worth exploring because it greatly affects how the disease is managed and the quality of life of the patient. The prevalence of the disease among middle and lower-class individuals is high making it difficult to seek medical care and receive the right treatment. Issues like the level of income, access to healthcare facilities, and perceived burden of taking medications lead to poor adherence to the desired treatment plan (Polonsky & Henry, 2016). The result is increased morbidity and mortality, increased emergency visits, hospitalizations, and the cost of managing complications. This project serves to address the challenge of adherence to treatment using regular phone calls and reminder cards to patients. The strategy can be effective in reaching out to patients from all socioeconomic classes and reminding them about the collection of drugs, monitoring of blood sugar levels, and attending appointments with their primary care providers.

The discipline of nursing holds the values in its heritage and tradition that translate to sustaining caring, humanity, and health for all. The role of nurses does not only lie in the provision of care to the ill, but also in the promotion of health in the communities through preventive strategies. This project contributes to the discipline of nursing through the integration of preventive strategies to manage diabetes and the promotion of evidence-based practice use in healthcare today. The project targets individuals with type 2 diabetes to ensure effective strategies are laid to help providers to reach people in the community to promote preventive care. The project compares the approaches of using computerized automated reminder diabetes systems (CARDS) and telephone calls/SMS to improve adherence to diabetes treatment. The project demonstrates the need to implement strategies that are evidence-based to improve the quality of care and patient outcomes.

Project Purpose Statement

The purpose of this project is to analyze how adherence to type 2 diabetes treatment can be improved to address the increasing rate of the disease today. The project informs providers on the use of reminder cards and telephone follow-up on office visits as a strategy to improve adherence to the management of the disease.

 

Background and Significance

Diabetes is a chronic condition that requires continuing medical care and patient self-management to reduce the risk of complications. The complexity of the disease makes it difficult to be controlled medically making its management a team effort between the provider and the patient. As a long-term disease, the quality of life achieved is dependent on the individual efforts through adherence to medication and lifestyle changes. The burden of suffering due to diabetes is increasing despite significant investment in clinical care and pharmaceutical research (CDC, 2020). The United States is among the countries burdened by the disease with significant impacts on mortality, morbidity, and healthcare costs observed. Additionally, the disease that mostly affected people over the age of 45 years now affects more children and youths. There is a need to focus on strategies beyond primary and secondary prevention to effectively improve the quality of life for those affected by the disease.

The use of health information technology presents numerous opportunities for improving and transforming healthcare. Diabetes care is among the area that has demonstrated the effective use of technology through new devices for blood glucose monitoring and incorporation of EHR systems into patient management (Doherty, 2020). This project uses a different approach to the use of technology in managing diabetes. Today, most patients have access to telephones that can be used to communicate care including scheduling of appointments. This project utilizes technology to improve compliance with diabetes treatment. The physicians will be able to initiate timely follow-up upon seeing patients, remind them about taking drugs, and book appointments. On top of this technology, the use of computerized automated reminders can be of importance to many individuals with access to smartphones and computers. These approaches will serve to ensure patients are reminded about checking their blood sugar levels and recording relevant comments when necessary.

Effective management of diabetes involves adherence to medication intake and timely follow-up of patients. It takes a lot of time for healthcare providers to educate patients about self-care only to leave them less motivated to manage their condition. Research establishes that only 77% of patients with diabetes take insulin as prescribed and about 85% remember to take their medications (CDC, 2020). Additionally, fewer than half of diabetic patients monitor their blood glucose and only a few closely follow instructions about lifestyle modification for diabetes management. Diabetes management is a collaborative process that requires sacrifice from the patient and follow-up from healthcare providers. This project aims at improving the care of diabetic patients upon leaving the facility through reminders to take their drugs, attend subsequent visits, and other lifestyle changes that can improve their quality of life.

PICOT Question

The PICOT question guiding this project is as follows:

In elderly patients with type 2 diabetes (P), does the implementation of Computerized Automated Reminder Diabetes System (CARDS) and telephone follow-up on office visits (I) compared to no follow-up (C) improve medication adherence (O) within the first three months of treatment (T)?

Literature Review

The key terms used to guide the search for relevant literature included: Diabetes mellitus type 2, medication adherence, Computerized Automated Reminder Diabetes System (CARDS), telephone follow-up

A key contributor to the high rates of mortality and morbidity of the patient with type 2 diabetes is chronic poor metabolic control. Although various strategies are now available including an array of pharmacological interventions, more than 50% of the patients fail to achieve adequate glycemic control. Studies indicate that the lack of integrated care and the utilization of appropriate technologies contribute to this problem (Polonsky & Henry, 2016). Poor medication adherence is associated with problems like inadequate glycemic control, higher medical costs, and higher mortality rates. There is increasing support for the use of innovative strategies to address the challenge of medication adherence alongside new approaches that can make the process of taking medication less burdensome. Polonsky and Henry (2016) recommend the use of behavioral innovations to increase the patient’s adherence to medication upon leaving the healthcare facility.

Management of diabetes requires a multidisciplinary team approach centered on the patient to achieve ideal outcomes. New approaches for diabetes care are required to allow patient interaction and education outside of the traditional office visit (Muegge & Tobin, 2016). Recent approaches have focused on bringing the patient data collected at home to help in modifying treatment plans for patients. In a randomized control trial involving 483 diabetic adults, it was observed that the use of self-monitored blood glucose data (SMBG) improved HbA1c levels over 12 months of follow-up (Muegge & Tobin, 2016). This research linked the SMBG data into computer systems allowing patients to be reminded when to record their glucose levels. The availability of technology interventions to diabetes control should be utilized to reduce the burden of the disease and promote the treatment of patients in primary care settings.

The goal of diabetes management is to achieve optimal glycemic control and to prevent complications. One of the challenges to achieving this goal is clinical inertia that refers to the inability to commence and intensify treatment (McGloin et al., 2020). To address this challenge, empowerment is recommended whereby the interventions made are aimed at equipping patients and families with self-awareness, knowledge, and skills to become managers of their condition. A study was conducted to evaluate the effectiveness of telemonitoring with telephone support on achieving glycemic control in patients commencing insulin therapy. During the intervention period, phone calls and SMS were used to reach out to patients with actions like health education and reminders incorporated. It was observed that the intervention empowered patients in self-management of the disease with the potential to meet safer and more effective care in insulin initiation (McGloin et al., 2020). This study indicates that telemonitoring needs to be streamlined with healthcare delivery to effectively manage type 2 diabetes and other chronic diseases.

Diabetes and associated conditions are the major contributors to mortality and morbidity due to non-communicable diseases globally. While prevention is the key to reducing the number of cases, developing strategies for managing and reducing the complications of diabetes are of utmost importance to control the affected population (Kundury & Hathur, 2020). A pilot study was conducted to assess the effectiveness of phone calls and SMS interventions in improving the HbA1c levels among diabetic patients. During the messaging and calls, diabetes education was provided to patients. The education was also provided in the local language to improve understanding of the health education message. After 8 months of intervention, a significant change in the HbA1c levels was observed. Subsequent intervention using the same approach demonstrated lower levels of HbA1c indicating the benefits of a regular phone call-based system in managing diabetes (Kundury & Hathur, 2020). As mobile phone users are increasing in number, providing diabetes management education through mobile phone intervention could be a viable strategy for controlling diabetes.

Medication adherence is important for glycemic control, yet forgetfulness to take medications is the most common barrier during diabetes control. Most people find it difficult to maintain the schedules for taking medications including keeping track of their glucose levels leading to complications. Given the ubiquity of computers, diabetes self-management can be made easier using automated reminder systems. A recent study assessed the effectiveness of the reminder systems in the current diabetes applications used by providers and patients to track disease management. It was observed that the reminder systems, especially those that utilized SMS were effective in improving medication adherence (Jimenez et al., 2020). Most patients benefited from reminders in computer applications that promoted timely intake of drugs and other activities like exercise.

Critical Appraisal

The evidence provided above demonstrates strengths and weaknesses that can be observed when the two strategies in managing diabetes. There is sufficient data to support the use of the CARDS and telephone follow-up strategies to promote adherence to treatment. The provided evidence consists of research from randomized controlled trials and cohort studies that have compared the interventions with other strategies. The evidence provided has focused on the use of technology to inform new changes in healthcare that could improve the quality of life of diabetic patients. These studies highlight the advantages of phone-based follow-up strategies that make it one of the best alternatives for diabetes management today. One of the weaknesses observed is the lack of focus on the elderly population that is a little caught up by technology. The use of reminder systems and SMS seems to be more effective among adolescents who can quickly interpret alarms and respond appropriately. Additionally, some studies only utilized a few participants making it difficult to generalize findings and recommendations.

The presented evidence provides an opportunity for further research using large study populations to provide more confident data. There is a lack of adequate studies on the use of these interventions among populations like the elderly. More research should figure out how the CARDS strategy and the use of phone calls can best suit the needs of those aged 65 years and above. Additionally, the healthcare system should train employees and provide adequate funding to support diabetes follow-up services. The integration of diabetes management into the healthcare system remains a challenge leading to poor utilization of the proposed strategies.

EBP Standard

The chronic care model (CCM) emphasizes various strategies that align with diabetes management to promote effective control of the disease. Ongoing collaborative communication and goal setting between all team members should guide the interventions for diabetes management. According to the provided evidence, the use of computerized reminder systems and telephone follow-up on office visits can improve adherence to diabetes medication (Doherty, 2020). The standard guidelines for diabetes management require a mandatory outpatient visit one month after discharge followed by regular follow-up depending on the patient’s condition (American Diabetes Association, 2020). The CARDS and telephone call strategy provides an opportunity for patients across all social classes to manage diabetes while improving their quality of life.

Implications

The proposed project on type 2 diabetes management has serious implications for nursing education, practice, and research. This project identifies gaps in nursing care that can be addressed through research and the implementation of evidence-based practices. The project provides a solid defense to the incorporation of technology in promoting the care of patients with type 2 diabetes. The project provides more insight on the use of technology to follow-up diabetic patients and recommends education of this approach to nurses and students for improved quality care. Lastly, this project challenges nurses to engage in research to explore how the elderly and other disadvantaged groups can benefit from this approach that uses modern technology for the self-management of diabetes.

 

References

American Diabetes Association. (2020). Standards of care: Standards of medical care in diabetes—2020 abridged for primary care providers. Clinical Diabetes, 38(1), 10-38. https://doi.org/10.2337/cd20-as01

Centers for Disease Control and Prevention. (2020). Diabetes: National diabetes statistics report. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Jimenez, G., Lum, E., Huang, Z., Theng, Y. L., Boehm, B. O., & Car, J. (2020). Reminders for medication adherence in type 2 diabetes management apps. Journal of Pharmacy Practice and Research, 50(1), 78-81. https://doi.org/10.1002/jppr.1595

Kundury, K. K., & Hathur, B. (2020). Intervention through short messaging system (SMS) and phone call alerts reduced HbA1C levels in ~47% type-2 diabetics-results of a pilot study. PloS One, 15(11), e0241830. https://doi.org/10.1371/journal.pone.0241830

McGloin, H., O’Connell, D., Glacken, M., Mc Sharry, P., Healy, D., Winters-O’Donnell, L., Crerand, K., Gavaghan, A., & Doherty, L. (2020). Patient empowerment using electronic telemonitoring with telephone support in the transition to insulin therapy in adults with type 2 diabetes: Observational, pre-post, mixed methods study. Journal of Medical Internet Research, 22(5), e16161. https://doi.org/10.2196/16161

Muegge, B. D., & Tobin, G. S. (2016). Improving diabetes care with technology and information management. Missouri Medicine, 113(5), 367–371. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139833/

 

Polonsky, W. H., & Henry, R. R. (2016). Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Preference and Adherence, 10, 1299–1307. https://doi.org/10.2147/PPA.S106821

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