Factors Involved in Type 2 Diabetes and Evidence-Based Practice

This literature review identifies factors involved in type 2 diabetes management and evidence-based practices for its treatment. The study suggests several drugs that have components beneficial for managing the disease. The paper also highlights a randomised study using pragmatic cluster which showed that existing generalist practice nurses without prescribing rights were effective in comparison with that of the usual primary care for type 2 diabetes.

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PROFESSIONAL NURSING
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Title:
Factors involved in causing type 2 diabetes and evidence –based practise carried out related
to it.
Abstract
Background
Conduction of literature review is a significant part of the research process which
helps to identify the components of the area of interest. Conducting a literature review helps
to identify the gaps in the research. There are several types of literature reviews, like primary,
secondary and tertiary literature reviews.
Aim
The paper aims to understand the disease diabetes through the studies carried out in
the various papers.
Methods
For the purpose of carrying out the studies, various databases were searched like the
Pubmed, Medline, JSTOR and Google Scholar. The key words searched were diabetes, type
2 diabetes, HbA1c, diabetes causing factors. The papers that were searched using these
databases were published between the years 2012 and 2018.
Findings
This study helps to recognise the factors that are involved in the particular disease
management which were identified as being lifestyle management, adherences to medicine
and increasing the glycaemic controls. Additionally the use of the Patient Engagement and

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Coaching for Health (PEACH) program through a controlled and randomised study has been
discussed which helps to promote care to the patients affected with the concerned disease.
Relevance to clinical practise
The study suggests several drugs that has components which are beneficial for
managing the disease of concern. Some of the types of agents are included are Metformin
which helps to decrease the resistance to insulin. It also reduces the hepatic glucose output
and enhances the peripheral glucose utilisation.
Conclusion
To investigate the nursing practise of patient engagement with the procedure of
coaching for health, randomised and controlled trials are conducted with a pragmatic cluster.
Key terms: Diabetes, type 2 diabetes, HbA1c, diabetes causing factors, PEACH program
Body of the literature review
Introduction
Conduction of literature review is a significant part of the research process which
helps to identify the components of the area of interest. Conducting a literature review helps
to identify the gaps in the research. There are several types of literature reviews, like primary,
secondary and tertiary literature reviews. In case of primary, the sources that are used refer to
the original sources which are based on the observations that are perceive directly by the
researcher. It can be any peer- reviewed journal or a published articles and reports. The
secondary literature reviews involves the data that is obtained from sources of interpretations
and evaluations that are conducted based on the primary sources of the literature. Finally in
case of tertiary, the sources are mainly the textbooks or articles of encyclopaedia and
guidebooks which represent a collection of the primary and the secondary literature sources.

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Aim and objectives
The paper aims to understand the disease diabetes through the studies carried out in
the various papers.
Methods
For the purpose of carrying out the studies, different databases were searched like the
Pubmed, Medline, JSTOR and Google Scholar. The key words that earched were diabetes,
type 2 diabetes, HbA1c, diabetes causing factors. The papers that were searched for were
published between the years 2012 and 2018.
Results
Author/ Date Journal Title Methodology
Blackberry 2013 theBMJ Effectiveness of
general practice
based, practice nurse
led telephone
coaching on
glycaemic control of
type 2 diabetes: the
Patient Engagement
And Coaching for
Health (PEACH)
pragmatic cluster
randomised
controlled trial
A cluster randomised
controlled trial is
employed, with general
practices as the unit of
randomisation.
Courcoulas et al.,
2014
JAMA Surgery Surgical vs Medical
Treatments for Type
2 Diabetes Mellitus-
A Randomized
Clinical Trial
Qualitative study design
through telephonic
conversations. A study is
a randomised clinical
trial.
Balkau 2012
Diabetes &
metabolism
Type 2 diabetes
treatment
intensification in
general practice in
France in 2008–2009:
Type 2 diabetic patient
characteristics along with
calloection of
HbA1c values,
hypoglycaemic treatment

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the DIAttitude Study and physician
characteristics from the
electronic records of a
panel of French general
practitioners. Factors
associated were studied
with the Cox model.
The type 2 diabetes is a complex health condition, which is responsible for imposing a
financial and health burden on the individuals. It had been suggested in studies that lifestyle
modification and adherence to proper medications can help in management of the disease
(Nauck, 2014). Medications must be administered with aim of reducing the blood glucose
level along with the reduction of risk of cardiovascular diseases. However it has been
reported in studies that about half the population of patient suffering form type 2 diabetes,
have been seen to obtain a glycaemical target of HbA1c that is about less that 7 %.
Additionally there have been reports that two-thirds of this population often die from
incidents of premature cardiovascular disease. Studies reveal that insufficient adherence to
anti-diabetes agents of oral nature represents < 80% of prescribed medication that is collected
and it is estimated that 36% and 93% of patients are applied with this (Ley et al., 2014). Most
of the studies carried out in this field confirms that an effective proportion of type 2 diabetes
patients often shows reduced adherence to medications which eventually lead to the
contribution that is less than the desired control.
Findings
The study is involved in the illustration of the several evidence based practises can
that be implemented in order to improve the conditions of management in case of type 2
diabetes. This study helps to identify the factors that are involved in management of the
disease which were recognised as being lifestyle management, adherences to medicine and
increasing the glycaemic controls. Additionally the use of the Patient Engagement and

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Coaching for Health (PEACH) program through a controlled and randomised study has been
discussed which helps to promote care to the patients affected with the concerned disease.
The study also highlights the importance of recognition of the HbA1c measures, which
identifies the therapeutic recommendations for the patient population (Balkau et al., 2012).
The study also puts forwards the importance of glycaemic control which includes the micro-
vascular complications of diabetes like retinopathy along with neuropathy and nephropathy
(Courcoulas et al., 2015). These complications are closely associated with the glucose and
HbA1c values. The study also states the importance of health personnel in terms of
improving the communications, cost addressing and improvement of the events that can have
a potential adverse effect.
Relevance to clinical practise
The study suggests several drugs that has components which are beneficial for
managing the disease of concern. Some of the types of agents are included are Metformin
which helps to decrease the resistance to insulin. It also reduces the hepatic glucose output
and enhances the peripheral glucose utilisation. This results in approximately 1-2 % of
HBA1ac decrease. Other such drugs includes Sulfonylureas, Meglitinide and
Thiazolidinediones, a-glucosidase inhibitors, Bromocriptine and Colesevelam. These reduce
HBA1ac to 1-2%, 0.5-1.5 and 0.5-1.5%, 1-2%, 0.5%-0.8%, 0.5%-0.8% and 0.5-2.0%
respectively (Inzucchi et al., 2015). The barriers of the adherence process includes the patient
factors like fear, skill and knowledge, self-reliance, depression, beliefs related to health, Lack
of confidence in benefits of medication that might be in future or immediate action and the
remembrance of the doses. The respective regimen factors associated with the patient factors
includes complexity of regimen, dose frequency, cost, adverse events and the lifestyle

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interference. The study also describes the t hypoglycaemic treatment intensification that have
been followed for a period of 14 years. The data shows that the Patients with at least two
HbA1c values are a total of 17493 patients, Patients requiring treatment intensification are
3118 (18%) of patient population. Finally patients with treatment intensification after the
second HbA1c above the threshold values are 1212 (39%) of the affected population. the
randomised and the controlled trails that were conducted showed that the patients in the
intervention and control groups were almost same at baseline. The results suggested that the
PEACH program there were comparable outcomes to usual primary care in diabetes
(Blackberry et al., 2013). It was seen that the generalist role of a practice nurse without
prescribing rights was ineffective.
Conclusion
From the above discussion it can be concluded that type 2 diabetes represents a
chronic condition, the intensity of which varies with the treatment programs and the
complexity of the disease. The studies evidently represents that there is a significance relation
between the medication adherence and the other prevalent therapies. The factors that prove to
be barriers in the path of adherence are required to be identified and addressed for providing
proper management of disease. The paper also illustrates the significance of the role that is
played by the medical personnel in addressing the problems of adherence and suggests
methods in order to improve the conditions of management of the concerned disease. The
paper also successfully highlighted a randomised study using pragmatic cluster which
showed that existing generalist practice nurses without prescribing rights was effective in
comparison with that of the usual primary care for type 2 diabetes.

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