Barrier to the self-management of type 2 diabetes in elderly people

Academic and Practice
Enquiry
1

Contents
TITLE: “Barrier to the self-management of type 2 diabetes in elderly people”........................3
Introduction................................................................................................................................3
Methodology..............................................................................................................................4
Results........................................................................................................................................8
Theme 1: Experiences of self-management of type two diabetes..........................................8
Theme 2: Gaining education and knowledge supports the self-management of type two
diabetes.................................................................................................................................11
Implementation of findings......................................................................................................14
Conclusions..............................................................................................................................15
References................................................................................................................................15
APPENDIX..............................................................................................................................22
2

TITLE: “Barrier to the self-management of type 2 diabetes in elderly people”
Introduction
Diabetes mellitus is referred as the metabolic disease which causes high level of blood
sugar. The insulin hormone move sugar from blood into cells to be stored or utilised for
energy. The untreated high level of blood sugar can damage the kidneys, eyes, nerves and
other organs of body. Being overweight increases the risk of diabetes as it makes the cells
more resistant to insulin effects on blood sugar.
The following assignment is based on the barrier to the self-management of type 2
diabetes in elderly people. Diabetes mellitus is an adverse health concern within global
healthcare settings (Tangvarasittichai , 2015) .There are two types of diabetes mellitus for the
purpose of this assignment type 2 diabetes (T2D) will be referenced.
The disease is experienced by patients with a lack of potency to use or produce insulin
effectively (Tangvarasittichai, 2015). Globally, diabetes is the most prevalent disease evident
from the reporting of 425 million adults in 2017, which is projected to increase to 629 million
by 2045 (Ogurtsova et al., 2017 : WHO, 2018).Centres for Disease Control and Prevention
(2014) has highlighted that, serious complications emerge if diabetes mellitus is not
adequately controlled resulting in outcomes such as cerebrovascular disease, kidney failure,
coronary heart diseases, as well as neuropathy diseases. To minimise complications and poor
management individual must possess adequate knowledge needed for effective management
of their diabetes(Young-Hyman et al,2016). Azreena et al. (2016) also demonstrated that
there are several factors which impact the patient’s knowledge about diabetes outcomes, for
this reason this has inspired me to select this topic in order to raise further health
consciousness of the implications it could left on a person, if untreated due to lack of
information or care being given to elderly people with T2D.
3

This project is based on the title "Barrier to the self-management of type 2 diabetes in
elderly people". The main reason behind choosing this topic for literature review is that it
assists in gaining deep knowledge on the topic by performing in depth research. It helps in
getting information and knowledge about the experiences of self-management of type 2
diabetes along with the education and knowledge that supports its self-management. This
assists researcher in determining the barrier that may occur in self-management of type 2
diabetes. This study not only support the researcher in enhancing the knowledge, but the
research has academic importance also. This study act as a base for other scholars to perform
further research on the topic.
An integrative literature review is essential for this study, as it helps in widening the
understanding surrounding the answers to the chosen research question; it is also essential for
healthcare workers to identify the gaps during patient assessments and when making
treatment recommendation based on evidenced-based research (Torraco, 2016).
Methodology
Literature reviews are important as they help to identify dated concepts on diverse
literature topics by providing debates finding on different theories (Snyder, 2019; 2016).
Literature reviews also help to identify evidence-based practice (EBP), which is defined as
clinical core skills that teach a healthcare professional the knowledge they should acquire or
gain from research (Tavares de Souza et al., 2010). EBP uses literature review as a form of
research knowledge in enhance knowledge decisions concerning patient care . A qualitative
methodology was used for this review because; it explains the observations of the study and
helps to develop concepts or hypotheses for potential quantitative analysis (Miller, 2011).
Qualitative analysis helps to discover trends in thought and opinions and dive deeper into the
problem (Miller, 2011). Qualitative research is reflexive, meaning that the research process is
determined by the researcher's own values, experiences, and interests (Qu and Dumay,
4

2011).This was particularly useful in answering my research question ,as it seeks to
understand patient experience in order to determine barriers faced with T2D. One of the
advantages of qualitative research is allows researchers to compare finding with previous
research around same topic and determine level of transferability (Tong and dew,2016).
However a disadvantage to qualitative research is the difficult in replicating research to the
same degree of certainty that quantitative research allows, this due to small sample size
(Atieno,2009).
Several electronic databases searched was used for this literature review which includes;
BMC, PubMed, CINAHL, Google Scholar, Science-Direct, and Medline, as these were
appropriate nursing databases that provide evidence-based literature relevant for this subject
(Wright et al., 2015). In order to attain an additional number of articles, the Snowballing
technique was utilised (Duraman et al , 2015) in which the list of references of the acquired
research articles is utilised for identifying more articles (Refer to Table 1 below).
Table 1: Databases Used for this Research
BMC Nursing BMC Nursing is an open-access peer-
reviewed nursing journal which is published
by BioMed Central and covers all of the
aspects of nursing training, research,
practice and education (BMC Nursing,
2020).
PubMed PubMed is a free database of NIH (National
Library of Medicine) that provides support
in the search and acquisition of literature
related to biomedical and life sciences (NIH,
5

2020).
CINAHL CINAHL is regarded as the most
comprehensive database for nursing and
allied health journals (EBSCO, 2020).
ScienceDirect ScienceDirect is the peer-reviewed scholarly
literature platform of Elsevier
(ScienceDirect, 2020).
Google Scholar Google Scholar is a web search engine that
can be accessed freely and have metadata or
full-text scholarly articles throughout an
array of disciplines (Zientek, et al., 2018).
Population, Exposure, Outcome (PEO), is a well-known, recognised formula which
helps in identifying interventions, problems and outcome (Fawcett, 2016). It allows
researchers to search for the evidence to produce an appropriate literature review within the
context (Fawcett, 2016). The use of PEO in this review is illustrated in Table 2 below
Table 2: Matching review question to PEO
P (Population) Elderly people with Type 2 Diabetes? age
range (65-74)
E (Exposure) Diagnosed with Type 2 Diabetes
O (Outcomes) Improving self-management of diabetes
6

The keywords used for searching the relevant literature includes: ‘Type 2 Diabetes’,
‘Elderly People’, ‘Self-management’, and ‘Barriers’. Moreover, the searches generated about
230 qualitative articles, after the application of certain exclusion criteria, the number reduced
to 60 articles, which among them the most eight (8) relevant ones where were selected for
further review purpose. Also, to filter research articles a ‘AND , ‘OR’ was used to help
narrow down research to be more specific to research question. (Garg,2016).
An inclusion and exclusion criteria were applied to identify the content needed to
address the research question giving the optimum outcome and avoiding any deviation by
averting articles that do not meet the criteria (Gosall and Gosall,2012).
Two themes emerged from the data extraction which were Gaining education and
knowledge supports the self-management of type two diabetes and Experiences of self-
management of type two diabetes (see appendix table 2 and 3).
Table 3: Inclusion and Exclusion Criteria
Inclusion Criteria Exclusion Criteria
Primary research article Secondary research articles
Published in the English language Research samples consisted of children with
Type 2 Diabetes.
Published within the last ten years Research where participants primarily lived
with other illness than Type 2 Diabetes.
Qualitative research article:
phenomenological, grounded theory,
Quantitative studies
7

descriptive, ethnography
Full text articles Letters
Commentaries
Reviews
Discussion papers
Involved patients living with Type 2 Diabetes. Newly diagnosed patients
Research samples consisted of adults of
working age only
I initially excluded non -UK Research,
however due to lack of UK based studies with
was amended to include research as there
more in-depth research from other countries
Research investigated lived experiences of
service users in the workplace or labour
market
Research on Type 1 diabetes
Research Question: What are the barriers to the self-management of type 2 diabetes
in elderly people in the UK?
Results
There are two main themes of study which are emerged from 8 selected articles.
These themes include: "experiences of self-management of type 2 diabetes" and "ginning
8