Glycaemia Control for Patients With Type 2 Diabetes - Diabetes Mellitus

Running Head: DIABETES MELLITUS 1
Impact of Adherence to Recommended Treatment On Glycaemia Control for Patients
with Type 2 Diabetes
Name of Student
Name of Professor
Institution Affiliation
Date

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Diabetes mellitus
Diabetes type two is one of the most common chronic disease globally. In the
year 2018, the prevalence of diabetes in the US was approximately 34.2 million,
which is 10.5% of the total population (Abdullah et al., 2019). Of these numbers, over
33 million have diabetes type two while the rest have diabetes type 1. Of the 34.2
million Americans who have diabetes, 26.8%, which is approximately 14.3 million
people, are above the age of 65 years. Every year, at least 1.6 million Americans get
diagnosed with diabetes type two. People with diabetes type two experiences excess
glucose in the blood due to failure by the body cells to absorb the glucose, which is
needed by the body to provide energy (Kauppila et al.,2019). The risk of developing
diabetes type two increases with age and also for people who are overweight. Lack of
physical exercise also contributes to increased risk of diabetes type 2. Some of the
risks associated with diabetes include increased risk of cardiovascular diseases such
as stroke and could also affect eyes, kidneys, and feet (Romakin &
Mohammadnezhad, 2019). Given the complications associated with diabetes type 2,
every person who is diagnosed with the disease must follow the treatment procedure
recommended by the doctor. This document examines the impact of adhering to the
recommended treatment on blood glucose levels.
PICOT question
A research question is a vital element of research because it outlines the factors
being investigated in the study. The PICOT framework is fundamental in designing
evidence-based nursing research. therefore, the PICOT framework is used to examine
the impact of adhering to recommended treatment on blood glucose level
P- Among diabetes type two patients
I-Adhering to recommended treatment

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C-Not applicable
I-Improvement of blood glucose control
T-Not applicable
The PICOT research question is: Does adherence to recommended treatment help in
improving blood glucose(glycaemic) control for patients with type two diabetes?
Systematic review
The global prevalence of diabetes type two is increasing at an alarming rate.
Patients are, therefore, advised to strictly follow the recommended treatment plan to
avoid suffering from the adverse effects caused by high blood glucose levels. There
exists a wide range of interventions that are aimed towards improving glycemic
control for diabetes type 2 patients. Some of these interventions include; exercises,
healthy diet, medication, and change of lifestyle to avoid habits such as smoking and
alcohol consumption (Candler et al., 2018). Data in this systematic review was
obtained in databases such as Medline, Embase, CINAHL, IPA, PubMed,
PsychINFO, and Cochrane. The articles were published between the years 2000 and
2013. The review contains 52 studies examining the adherence to treatment
recommendations for patients with type two diabetes. The 52 studies met the
inclusion criteria, and they were assessed for research design and methods used for
measuring adherence to treatment and the impact that it has on glycaemic control. Of
the 52 studies, 14 were published between the year 2000-2009, while 38 reviews were
published between 2010-2013. Forty-six studies indicated that treatment adherence
significantly helped in glycaemia control.
In comparison, the results of the six other studies did not show a relationship
between adhering to medication and improved glycaemic control (Guerci et al., 2019).
From the 52 studies, the adherence to treatment plan was between 36% and 93%. The

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patients who were below 60% adherence level mostly reported joint pains, and their
blood glucose levels were higher than those whose treatment adherence was above
60% (Hammad et al., 2017). The patients whose adherence was above 85% showed a
significant improvement in glycaemia control. The majority of the patients who
reported to have adhered to the treatment plan indicated that they followed the
treatment plan every day of the week. Analysis of the studies also showed that older
patients adhered to the treatment plan. Patients who had been diagnosed with diabetes
type 2 for a long duration were more likely to adhere to treatment plans. The patients
did not have any foot diseases, and their weight was within the recommended BMI.
There is no single treatment intervention that was determined to improve blood
glucose control. Adhering to two or more treatment interventions was found to
improve blood glucose control for patients with diabetes type two. The studies were
mainly conducted using Self-report correctly using the Summary of Diabetes Self-
Care Activities questionnaire. The questionnaire was used to evaluate medication
adherence, but also other methods such as interviews were used.
Describe your systematic review and include an error analysis.
The systematic review focuses on the impact that adherence to treatment plan has
on control of glycaemia. The systematic review involved conducting of literature
review to identify evidence-based research articles evaluating the effect that adhering
to treatment has on blood glucose levels for patients with diabetes type 2. The search
strategy used only the English language. Each of the studies included in the review
was also analyzed to establish whether adherence to recommended treatment was the
primary measure of outcome. The review also included an assessment of the
measurement techniques and the methodology used to carry out each of the studies.

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The fifty-two studies used in this review were conducted in 16 different countries.
However, 52% of the studies were carried out in the United States of America, while
17% of the studies were conducted in Europe, and the remainder were conducted in
Asia (Rivas et al., 2019). Thirty-eight studies were published between the years 2009
and 2013. Thirty-five studies were carried out using randomized controlled trials,
while ten of the studies used a time-series design while the rest were cluster
randomized trials.
One of the potential errors in the systematic review is the selection of study
participants. The studies included in the review which did not use a randomized
sampling technique could have prevented a mistake of sampling, and hence some
respondents who should not have participated in the study might have been included.
The other potential error is an overestimation of results. This might arise as a result of
the respondents giving inaccurate information regarding their adherence to medication
or overestimating the impact that accession has had on their health.
Determine an evidence-based quantitative article from the search that contains
an evidence-based randomized control trial.
The evidence based quantitative article used in this study is title “Treatment
adherence and its associated factors in patients with type two diabetes; Results from
the Rio de Janeiro Type 2 diabetes study”. The article was found in the PubMed
journal which is famed for evidence-based high quality peer reviewed journals. The
article was published in Nov 2018.
Summary of selected case study
Various studies conducted across the globe have shown that adherence to the
recommended treatment helps in controlling glycaemia. According to Marinho et al.

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(2018), when patients with diabetes type two adhere to treatment recommendations,
the blood glucose level is kept under control, and patients are unlikely to suffer from
complications associated with diabetes type two. A study conducted in Rio De Janeiro
among patients with diabetes type two indicated that patients who adhered to the
treatment recommendations up to the point of 90% had better control of their blood
glucose levels (Loganathan et al., 2017). The study was carried out based on the
summary of diabetes self-care activities(SDSCA). Good adherence to treatment
established to be five days and above each week for each SDSCA item. The SDSCA
items applied in this study include; diet, medication, foot care, smoking, exercises,
blood sugar testing, and self-care recommendations by the doctor. The study found
out that 59.3% of the respondents adhered to the foot care recommendations, while
only 56.1% adhered to the guidelines on blood glucose monitoring (Marinho et al.,
2018). On the recommendation on a diet, 29.2% of the respondents adhered to the diet
for at least five days a week while the adherence to exercise was even lower at 22.5%.
On the evaluation of the results of the study, it was determined that patients who
generally adhered to the recommended treatment had a lower BMI, a better profile of
serum lipid, and higher values of functional capacity (Misra et al., 2019). The study
also found out that the patients who adhered to the recommendations had an
emotional and occupational performance domain of SF-36 and higher HDL levels of
cholesterol. The prevalence of pain in the lower and upper limbs was also lower for
patients who strictly followed the treatment plan. Some of the factors which were
related to good adherence include younger age, lower levels of BMI, and better
occupational performance (Khunti, Khunti & Khunti, 2019). Patients who had
microvascular complications were also keen on adhering to treatment. Patients who

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adhered strictly to medication had lived with diabetes for a long duration and lower
levels of HbA1c.
Furthermore, the study established that patients who had lower adherence to the
recommendations experienced acute pain in the upper limbs. This pain is caused by
excess glucose in the blood. Patients who did not adhere to the recommended exercise
plan reported experiencing peripheral neuropathy and pain in the joints. The study
concluded that good adherence to treatment was determined by emotional and
physical performance, and it resulted in improved glycemia control.
The study approach, sample size and population studied
The study used a cross-sectional approach, and it was carried out in Rio de
Janeiro in Brazil. The study involved 476 diabetic types of two patients who regularly
attend an outpatient clinic of a University hospital involved in tertiary care (Vluggen
et al., 2018). The exclusion criteria used for the study were disqualifying patients who
faced difficulties in understanding the questions in the questionnaire, either due to
cognitive or literacy issues (Singh et al., 2017). Patients who could not agree to
participate in the study or were unavailable were also excluded. The local Ethics
Committee approved the study since it had met all ethical research requirements. The
participants signed a consent form to validate that they had agreed to be involved in
the study. Before the study began, all the participants undertook a complete clinical
and laboratory examination, which is a standard procedure to ensure that all the
participants were having diabetes type 2 (Balkhi et al., 2019). The blood glucose
levels of the patients were also measured and compared with past data to determine
the changes from time to time. Aspects such as joint pain, which could make it
challenging to adhere to the physical exercises plan, were recorded in the SF-36
questionnaire. The participants were asked to identify the activities that they find

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difficult to perform, and they were recorded in the Canadian Occupational
Performance Measure(COPM). The higher the values of COPM, the better the
occupational performance of the participant.
Application of the evidence from this review to my practice, specifically in my
overview.
From the systematic review and the evidence from the case studies, it is clear that
adhering to recommended treatment helps on control of glycaemia levels and hence
improving the quality of life of patients with diabetes type 2(Atif et al.,2019). This
evidence can be applied in assisting diabetes type 2 patients to improve their health
outcomes. Most patients with type 2 diabetes find it difficult to follow the instructions
issued to them by the doctors because some of them are very demanding. This is
especially common when a person has just been diagnosed with the disease. Most
patients have reported finding it challenging to stop habits such as smoking and
consumption of alcohol (Lim et al., 2016).
Other people struggle to adhere to the diet recommendations as well as physical
exercises. To apply this evidence and help diabetes type 2 patients, community-based
education programs should be carried out. Research has proved that community-based
education is beneficial in improving the outcomes of patients who have diabetes. The
programs will aim at educating patients with diabetes type two the importance of
adhering to the treatment plan recommended by the doctor 100%(Pokhrel et al.,
2019). Using the evidence from this research, people with the disease will be
convinced and will understand the tremendous positive effect that is associated with
adhering to treatment recommendations.
Evaluation of the outcomes, identifying validity and reliability.

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The outcomes of research indicate that there is a positive relationship between
adherence to recommended treatment and improvement of blood glucose control.
This, therefore, means that every recommended treatment intervention is critical in
controlling glycaemia which in turn helps in improving the health outcomes of the
patient (Mody et al., 2019). Patients should adhere to recommended lifestyle changes,
medication, diet, as well as a physical exercise plan. The studies indicated that good
adherence means following the recommendation for at least five days a week.
Adhering to the advice for all seven days of a week helps in improving blood glucose
control further (Neto et al., 2017). Good control of glycaemia means that a person will
avoid complications associated with diabetes type two. These complications include;
foot ulcers, increased risk of stroke, and risk of a heart attack.
The study is valid because the data was obtained from reliable databases, which
include Cochrane, PubMed, Medline, and EMBASE. The study is also valid since all
the studies are peer-reviewed, and the methods used in carrying out the reviews have
been thoroughly evaluated. The inclusion criteria are also thorough, and the people
who were found not to be qualified were not included in the study sample. The
research used randomized controlled trials to examine the impact of adhering to
recommended treatment on glycaemic control. The results of the study are reliable
because the results of the study are similar to most other studies carried out on the
same subjects, and hence the results of this study can be applied in different places.
Discussion on if the study contained any bias.
The study could have association bias. This is because the data was collected
from diabetes type 2 patients attending tertiary university hospital. There might,
therefore, be other diabetes types two patients attending other clinics or who are not

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attending hospital at all. Therefore, the results of this section of the population could
be different, and if included, the results of the study could have been different.
The level of evidence identified in the review.
The level of evidence in the review can be classified as highest since it uses
randomized controlled tests (Tharek et al., 2018). The level of evidence is regarded to
be highest because the studies included in the review are not biased. The studies
included in the review also have less probability of having systematic errors. The
quality of the data used in the systematic review is also very high since the exclusion
criteria ensured that only respondents who were appropriate for the study were
included. The review also used a good number of studies amounting to 52, and the
studies were carried out in different parts of the world and hence meaning that it
represents the scenario in different areas.

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