Effectiveness of Self-Management Interventions for Diabetes
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This document discusses the effectiveness of self-management interventions for diabetes and their impact on patient outcomes. It includes findings from systematic reviews and meta-analyses, highlighting the importance of self-management in improving diabetes management.
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Running head: NURSING ASSIGNMENT CRITICAL APPRAISAL WRITTEN REPORT Name of the student Name of the university Author note
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1NURSING ASSIGNMENT As per the World Health Organisation, diabetes is one of the critical healthcare complications due to which the global morbidity and mortality rate is increasing [1]. As per the statistical data provided by this organisation, the number of patients suffering from diabetes has increased more than thrice since 1980 [1]. As per the latest study, 422 million people around the globe is suffering from diabetes and the prevalence of disease has doubled from 4.7% in 1980 to 8.5% in 2014. Moreover, if the morbidity and mortality rates are considered, more than 1.6 million people were registered dead due to their improper diabetes management [4]. Further as per researchers improper management of diet, physical inactivity, improper weight management and addiction to different substances increases the morbidity and mortality associated with this disease [2[. Hence, application of self-management could be an effective means to increase the diabetes management rate among patients suffering from chronic condition. The PICOT question selected for collecting evidences from recent literatures was as follows: PopulationInterventionControlOutcomeTime Patients affectedwith chronic diabetes. Self- management Pharmacologica l interventions Improves patient condition Within6 months PICOT question:do the application of self-management interventions compared to the pharmacological interventions helps to improve the patient condition within 6 months?
2NURSING ASSIGNMENT To find evidences based on this PICOT question, the database PubMed was searches with several effective keywords, connected with Boolean Operators such as AND, OR and NOT. The keywords are as follows: “self-management AND Diabetes AND effectiveness”, self-management AND Diabetes OR effectiveness”, “self-management AND Diabetes NOT effectiveness”,“self-managementAND/OR pharmacologicalinterventionANDdiabetes AND effectiveness AND systematic review”, “self-management AND/OR pharmacological intervention AND diabetes AND effectiveness AND systematic review OR/NOT randomized control trail” “1 AND/OR 2”, “1 AND/OR 3”, “1 AND/OR 4”. The search was refrained with several inclusion criteria including research papers from 2013 to 2019 so that effective results could be obtained. 3 systematic review paper were found and the following section would discuss their level of evidence. The first article included papers from randomized control studies and hence, as per the level of evidence, the study was of Level I. Further, in this paper, studies of randomized control trail was collected from eight renowned databases including the Cochrane library and in the process, the researchers conducted the quality of the papers through the application of R AMSTAR critical appraisal tool. Hence, this paper was selected for the assessment [4]. The second article was included as it conducted a systematic review by including 14 researcharticlesthroughmeta-analysisandin thisprocessidentified12 interventions associated with self-management so that patients with diabetes could be provided with effective healthcare interventions.Further, the papers with randomised controlled trials (RCTs), non-randomised controlled trials, and quasi experimental studies were included in the paper, hence the level of evidence was level I [5]. The third article selected for this process included a research in which the researchers included32randomizedcontroltrailtounderstandtheself-managementactivitiesin
3NURSING ASSIGNMENT maintainingpatientcondition.However,itwasseenthatthepaperlackedproper recommendations and the competing interests in this aspect due to which the level of evidence of this paper decreased, it could be categorised in the level II of the evidence [6]. Hence, al the evidences indicated towards the effectiveness of self-management related intervention for the effective treatment of the diabetes among [patients, and in this process level I and level II articles with systematic review of randomized control trails were selected for the detailed analysis.
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Running head: NURSING ASSIGNMENT First author, year, title Study purposeStudydesign(inc inclusion exclusion criteria) Studypopulation & setting Intervention description Outcome measures FindingsLimitations Evidence Level Systematic reviews/ meta-analyses : Evidence Level I Captieux, M.etal. 2018, Supported self- managemen t for people with type 2 diabetes:a meta- reviewof Theaimofthe studyisto understandthe effectivenessof self-management amongpeople with diabetes type 2 and comparing theintervention toidentifythe best evidence for Systematicreview was conducted with MEDLINE, EMBASE, CINAHL, PsychINFO, AMED,BNI, CochraneDatabase ofSystematic Reviewsand Databaseof Inthissystematic review41studies withRCTasthe primaryresearch processwere selected from more than 40 countries so that focuses on the interventionsand self-management amongpatients Differentself- management strategieswere implementedin the patient’s so thattheir improper managementof diabetes conditionand itsadverse Primary outcome: patientswith type 1 and type 2 diabetes were ableto overcometheir diabetes condition effectivelywith applicationof Diverseself- management strategieswere foundtobe effective against thetype1and type2diabetes andincreased the ability of the patientsto overcometheir The paper did notinclude fine-grain detailsofthe metaanalysis studies included in the studydueto whichthe effectiveness ofthepaper
1NURSING ASSIGNMENT quantitative systematic reviews. the patientsAbstractsfor Reviewsof Effectiveness (DARE).And papers with 1993 to 2012 were selected for the assessment. Inthisaspect,the RCTs were selected for the assessment. Inclusioncriteria: paperswithinthe selected timeframe, inEnglish language,within the RCT study and withtype2 diabetes.Inthis processallthe short-term, medium term and long term interventionswere includedsothat interventionsand theireffectiveness couldbe understood. events could be loweredwith effectiveand accurateself- management skills.Further, the 97% of the caseswere inclusiveof interventions developedby thepatientsso that patients and theirabilityto implement self- management interventions associatedwith self- management technologies. health condition.affected. However,it was a level 1 evidence study.
2NURSING ASSIGNMENT withdiabetes managementwere selectedforthe analysis. Theexclusion criteriaincluded: language other than English,subjects with disorder other thandiabetes, interventionsother thanself- managementand paperswith improperdata strategiescould be identified.
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3NURSING ASSIGNMENT analysis process. Fredrix, M. 2018, Goal- settingin diabetes self- managemen t:A systematic reviewand meta- analysis examining content and effectivenes Theaimofthis paperisto understandthe effectivenessof goalsettingand diabetesself- management amongpatients sufferingfrom chronicdiabetic condition. Systematicreview wasconductedin severalhealthcare databasesandthe guidelinewhich wasusedforthis assessmentwas International Prospective Registerof Systematic Reviews. Inclusioncriteria: the papers that were includedinthe Thestudy population included patients with blood glucoseassociated self-management and in this process theirbehavioural changetechniques were determined. The intervention wasassociated toweight management andcontrolling theblood glucose level so thatpatients couldbe providedwith effective techniquesto improvetheir diabetes Primary outcome: associatedwith patient’s controlled weightand bloodglucose afterthe implementation of intervention. Secondary outcome: physical, psycho-social and behavioural Significant improvement amongpatients withdiabetes wasobserved afterweight management andblood glucose management associated effective treatmentand hence,thiswas determinedas TheBCT analysiswas notconducted effectively and hence,coding difficultywas observedin thiscase. Further,the fidelityofthe paper was not discussed. Thelevelof evidencewas type I level of
4NURSING ASSIGNMENT sofgoal- setting intervention s. studywasEnglish language,effective intervention related to self-management among the patients withdiabetes, withinthespecific time frame. Exclusioncriteria: language other than English,improper data collection and analysis, interventionother thanself- managementand managementmodification wereobserved inthis systematic analysis theeffective interventionfor diabetes management. evidence.
5NURSING ASSIGNMENT diseaseotherthan diabetes. Systematic review : Evidence level II Coyle,M. E.,2013, Self- managemen tactivities indiabetes care:A systematic review Theprimary objectiveofthis paperisto identify the wide rangeof interventions associatedwith self-management sothatits effectivenessin diabetes,its accurate frequency and its The researchers conducted a systematic review with the range of databases such as PubMed, Embase, CINAHL, andthe Cochrane Library and the range of timeline was inception to 2012. The inclusion 32paperswith RCTswere includedinthe paper, 513 patients with diabetes were assessed. In this twenty two paperincludedin thepaperasself- monitoringblood glucose.,whereas 25 papers discussed Thispaper discussed several interventions forthe discussionand monitoringof bloodglucose level,diet management and managementof physical Primary outcome:the patientswere ableto overcometheir diabetes condition. Secondary outcome: patientswere ableto overcometheir Thissystematic reviewfound thatdiet, physical activity,foot careandother associated healthcare conditionis effectivein diabetesself- management condition. The paper was unableto providethe detailsofthe physical activity or the type of diet or thedegreeof the interventions whichis requiredfor thehealthcare
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6NURSING ASSIGNMENT utilization among patients could be understood. criteriaincluded: paper with self- management skills, in English language, proper rate and frequency of the self- management intervention and the time utilized in self- care and the presence of disease related to type 1 and type 2 of the disease. Further RCTs, with about diet and self- management interventionsfor diabetes management. Further, 28 studies wereinclusiveof physicalactivity associatedself- managementfor such process. inactivityand footcarewere included in the studyas interventionfor diabetes managementso thatpatients couldbe providedwith effective means fortheir diabetes treatment. improperhealth and diet as well asphysical inactivity due to whichthe diabetic conditionwas controlled. However,the abilityofthe patientin adheringtothe conditionis deciding in this condition. development of the patients indiabetes condition. Asthepaper didnot includeda proper recommendati on and lacked thedegreeof interventions the paper was ofevidence level II
7NURSING ASSIGNMENT inpatient and outpatient programs were included in the paper. Exclusion criteria: Studies that focuses on interventions other than self- management, language other than English, subjects without type 1 or type 2 diabetes and improper study design with improper data
8NURSING ASSIGNMENT collection method
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9NURSING ASSIGNMENT References 1.Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology. 2014 Jan 1;2(1):56-64. 2.Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice. 2014 Feb 1;103(2):137-49. 3.Majumdar A, Sahoo J, Roy G, Kamalanathan S. Improper sharp disposal practices among diabetes patients in home care settings: need for concern?. Indian journal of endocrinology and metabolism. 2015 May;19(3):420. 4.Captieux M, Pearce G, Parke HL, Epiphaniou E, Wild S, Taylor SJ, Pinnock H. Supported self-management for people with type 2 diabetes: a meta-review of quantitative systematic reviews. BMJ open. 2018 Dec 1;8(12):e024262. 5.Fredrix M, McSharry J, Flannery C, Dinneen S, Byrne M. Goal-setting in diabetes self-management: A systematic review and meta- analysis examining content and effectiveness of goal-setting interventions. Psychology & health. 2018 Aug 3;33(8):955-77. 6.Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: a systematic review. Australian Health Review. 2013 Oct 1;37(4):513-22.