PICO Question Report: Education for T2D Patients in Acute Care

This report addresses a PICO question concerning the significance of patient education for individuals newly diagnosed with Type 2 Diabetes (T2D) who have been discharged from acute care. The report establishes a comparison between T2D patients who receive education on diet, exercise, medication, and regular check-ups versus those who do not. The introduction highlights diabetes as a prevalent lifestyle disease and underscores the necessity of patient education for effective self-management to prevent serious complications. The literature review supports the PICO question, emphasizing the importance of early diagnosis, glycemic control protocols, and the impact of education on patient outcomes, hospital readmissions, and healthcare costs. The report explores various aspects of diabetes management, including blood glucose monitoring, medication, nutritional assessment, lifestyle interventions, and insulin administration, to provide a comprehensive understanding of the topic. It emphasizes the need for patient education, including the differences between type 1 and type 2 diabetes, and the role of healthcare professionals in providing support. The report concludes by underscoring the benefits of patient education in improving patient autonomy and decision-making regarding their treatment and overall health.

Running head: PICO QUESTION
PICO QUESTION ON PATIENT WITH NEWLY DIAGNOSED T2D
Name of the Student
Name of the university
Author’s note

1PICO QUESTION
Introduction
Diabetes mellitus is a metabolic disorder in which the blood sugar level in the blood rises along
with prolonged high blood pressure. If diabetes is left untreated then it may lead to serious acute
conditions such as hyperosmolar hyperglycemic state, ketoacidosis. Long term conditions may
include chronic kidney disease, cardiovascular diseases, eye damage and ulcers (Dorresteijn &
Valk, 2012). Diabetes is a life style disease and can be maintained by maintaining proper diet
and life style. Therefore education is necessary for the proper self management of the disease. It
is a common ailment that is found all over the world afflicting more than 30% of the population
in almost every country. Due to the wide prevalence of diabetes it is necessary to take first hand
actions.
This paper aims to provide a critical research regarding the importance of education to
the acute care patients newly diagnosed with diabetes. It is necessary to address a PICO question,
in order to perform an evidence based search regarding the importance of education to newly
diagnosed patient. In order to do this a comparison has been brought between those diabetic
patients with education and without any education.
Each of the PICO terms is described by a wide range of literatures and a literature review
is provided supporting the PICO question
P- Newly Diagnosed patients discharged from acute care with type 2 diabetes
I- Educating patients regarding diet, exercise, medication and insulin therapy and regular check
up to control diabetes.

2PICO QUESTION
C- Compared to patients with no education and not following the recommended practices to
control diabetes.
O- Increasing nursing comfort with teaching the information.
The population chosen for this study is the patients with newly diagnosed diabetes who have
been recently discharged from acute care.
Management of the glycemic level in acute care patients is critical. Acute care patients
with T2D require specific glycemic control protocols. Early diagnosis and proper management of
diabetes can reduce the detrimental effects of diabetes to some effect even if it cannot be cured
fully (Haas et al., 2012).
This type of population has been taken for the research due to the fact that the acute care
patients, who are already under the burden of other ailments, require additional education to
manage the effects of diabetes. Further more different studies that patients having diabetes have
three fold chances of hospitalization compared to those with diabetes and the chances becomes
much higher with the acute care patients. Reports say that here had been 7.7 millions of hospital
stays with diabetes. Furthermore since diabetes can be easily managed by maintaining proper
diets and exercises and adherence to medications. This population had been suitable for my
research.
Literature review
According to the reports by Dorresteijn & Valk, (2012), Hyperglycemia greater than
140mg/dl is reported in22-46% of the non-critically ill patient. The data indicates that patients
without the prior diagnosis in patients can increase the risk of complications.

3PICO QUESTION
According to the International Diabetes federation, more than 415 million of people are affected
with diabetes globally. Most of the detrimental effects of diabetes are associated to the acute care
patients.
Reports say that about 70-80% of the patients with critical illnesses have become the
victims of the acute care diabetes.
According to Mayberry & Osborn, (2012), in patients without diabetes the plasma
glucose level is maintained within the range 70-100mg/dl. Maintenance of the normal glucose
level is essential for the proper functioning of the brain.
According to Evert et al., (2014), the primary goal for the study is the rapid evaluation of
the disease. Patients who are under acute care should be undergoing a clinical history and
physical examination including a metabolic panel. The critical evaluation of this paper is
necessary it discusses about the hoe the critically ill patients under acute care should be assessed
with diabetes. After the necessary assessments and examinations, the second step to the
management of diabetes is imparting education to the patient regarding the management of
diabetes.
Diabetes self management education may be considered as the critical element of care for
the people with diabetes and is essential in order to improve the outcomes in patients with
diabetes. It is necessary to provide an evidence based education to the acute care patients.
According to the paper by Peyrot et al., (2012), Being a newly diagnosed with diabetes
can be confusing and precautions and preventions taken from the beginning can really improve
the quality of life. At first it is really important to educate the patient regarding the
pathophysiology of the disease. They would be taught about the different ranges of the blood

4PICO QUESTION
sugar level and the level to which he belongs. Then it is necessary to advice the patients to keep
the blood sugar close to the normal by effective precautions. The patient should be acquainted
with all the knowledge regarding the adverse effects of high blood sugar levels.
According to Evert et al., (2014), the main goal of the diabetic management should
include be to recreate the high blood sugar level up to the normal level without causing low
blood sugars. Diabetes is of two types, it is necessary for the patients to understand the difference
between these two types a the management protocol varies with these two types, for example the
For type 1 diabetes one is treated with insulin replacement therapy and type 2 diabetic patient
requires therapies that normalizes the sugar levels.
To discuss about the interventions regarding the T2D in patients, we have come across a
lot of articles while brain storming through the search engines.
According to Malanda et al., (2012), the key principle of the self management of diabetes
is the self monitoring of the blood sugar level regularly. There are several blood sugar
monitoring devices available in the market to monitor the blood sugar level daily. According to
the author, people who monitor their blood glucose levels regularly and maintain a proper log
book to maintain the records, achieve better results. Acute cases of diabetes also require keeping
a close watch on blood and urine ketones.
There is portable glucose monitoring devices that can be used to monitor glucose
regularly. Newly diagnosed patients should be taught how to use the devices properly. According
to Clarke & Foster, (2012), a glycosylated hemoglobin cell that is glucose attached to
haemoglobin may remain viable up to three months. Therefore, it is required to measure the

5PICO QUESTION
average blood glucose control for the last three months as that would help to reflect the sugar
exposure to the cells.
Malanda et al., (2012), have argued that the electronic devices are always not effective in
monitoring the blood glucose level although there had been a wide spread increase in the sale of
different brands of glucose meter.
As per Inzucchi et al., (2012), there are curtain therapies which can be taught to the
patient to manage the further growth of the symptoms. Person having T2D can have high blood
sugar level right after the meal, even if very less carbohydrate type food is consumed. Medicines
called incretin based treatments can be used to control the post meal glucagon, and help to
mitigate the post meal blood sugars.
As food plays an important part in the management of diabetes. Careful nutritional
assessment is required to control diabetes. According to (Ajala, English & Pinkney, 2013), the
estimated nutritional requirement for the diabetic patients are same as that of the others of the
population, but the diets should be exclusively based on the metabolic needs of an individual.
Referral to an authenticated dietician can be advised for preparing a proper meal plan for the
patient. Emphasis should be given on the non carbohydrate type of food such as dietary fibers
and foods containing whole grains. Al-Khawaldeh et al., (2012) have emphasized that low
glycemic index food, rich in fibers should be encouraged.
In a population study performed by Inzucchi et al., (2012), revealed that people addicted
to alcohols are more prone to diabetes compared to that of the non drinkers. A greater risk ratio
indicates that diabetic symptom is directly proportional to alcohol consumption in patients.

6PICO QUESTION
Clinical trial data form Finnish Diabetes Prevention study and the Diabetes Prevention
Program (DPP) in the U.S has strongly recommended that obesity increases the risk of diabetes
in patients, discharged from the acute care. The clinical trials have proved that life style
interventions include regular physical activity permissible for the patient and moderate weight
loss. Powers et al., (2012) strongly supports the facts that obesity not only increase the risk of
diabetes but also increases the chance of other conditions like hypertension and the inflammatory
markers.
In case of patients with hypo glycemia, artificial intake of glucose can be taken. For acute
diabetes, oral glucose lowering medications and insulin should be continued.
According to Chen et al., (2012) Patients with newly diagnosed acute care diabetes may
face challenges during the administration of Insulin. The patient should be educated about the
process of application of the injection and the site of injection. The site of injection should be
rotated to prevent scarring. The patient should have a knowledge regarding storing of the insulin
vials. It is advisable to help the patient for choosing the types of syringe used in the injection.
Steinsbekk et al., (2013) suggests that it is necessary to educate the patients regarding the
disposal of the insulin syringes and the pens and they should be educated that the insulin syringes
should not be shared with anybody else.
For the patients in acute care facilities, it is necessary to set up an interdisciplinary team,
implementation of MNT. According to Peyrot et al., (2012), an individual can have pre-diabetes
which means that the blood glucose level is greater than the normal range but is lower than the
diabetic range. Proper education to patients can reduce the intensity of the diabetes.

7PICO QUESTION
According to Davies et al., (2013), the diabetic educators might face with a lot of
difficulties as some of the patients might feel embarrassed to admit that they don’t have any
knowledge regarding the disease. Therefore it is necessary to built up a relationship of trust, non
judgment and emotional safety between the client and the diabetic educator, such that it becomes
easier for the acute care patients to pay heed to the instructions.
Powers et al., (2017) has said that Education plays an important role in the Management
of diabetes as it assists the patients in managing the disease. The main aim of the self
management of diabetes is to turn the patients in to the managers of their disease. The
interventions are found to improve the clinical results. The main outcome of educating diabetes
patient is to enable them to take their own decisions regarding their treatment and encouraging
them to utilize the health system as a means for controlling diabetes. Another important outcome
is that it increases the patient autonomy.
As per the author Haas et al., (2012), education to newly diagnosed patients decreases
hospital revisits and also helps to curtail health care costs. Although it is difficult to engage the
acute care patients in their own treatment, the families of the patient can be involved in the
treatment regimen to provide a safer care to the critical care patients.
According to Das et al., (2013), a randomized control study shows that proper diabetic
education in acute care patients prevents complication when compared to the diabetic patients
without proper diabetic management education.
Al-Khawaldeh et al., (2012) have noticed the relationship between patient's literacy
regarding diabetes and the progression of chronic diseases. A total of 402 patients with
hypertension and diabetes were assessed, out of which symptoms in 114 patients were moderate

8PICO QUESTION
and rest of the population of the study showed acute diabetic problems. On assessing the patients
it was found that 94 out of the 114 students did have knowledge about the self management
techniques. The rest of the participants were found to be ignorant regarding the self management
education.
Many reports have emphasized on the fact that literary skills of the patient must be
considered while care to the patients. The mode of education to the patients should be simple
such for the critical care patients to perceive.
Hence it can be said that the literatures that have used in the literature review are
appropriate in addressing each of the parameters of the PICO question. The papers provides with
the evidences that education in diabetic patients can change the landscape of the disease and
result in better outcomes.
Conclusion
The literature review provides with the information that Diabetes is mainly a life style
disease and its self management techniques can mitigate the adverse situations related to
diabetes. Literatures have provided with evidences that proves that patients having education
regarding diabetes have led to faster recovery than those without prior education. The articles
used in the literature review could address the type of population chosen and the reason for
choosing them for the study. The articles proved how educations can help the newly diagnosed
patients to self monitor the glucose levels and administer them timely. It can be concluded that
initial evaluation, a proper management plan, glycemic control and referrals for diabetes
management can decrease the adverse effects in patients with acute care diabetes and provide
them with a better life style.

9PICO QUESTION
References
Ajala, O., English, P., & Pinkney, J. (2013). Systematic review and meta-analysis of different
dietary approaches to the management of type 2 diabetes. The American journal of
clinical nutrition, 97(3), 505-516.
Al-Khawaldeh, O. A., Al-Hassan, M. A., & Froelicher, E. S. (2012). Self-efficacy, self-
management, and glycemic control in adults with type 2 diabetes mellitus. Journal of
Diabetes and its Complications, 26(1), 10-16.
Chen, S. M., Creedy, D., Lin, H. S., & Wollin, J. (2012). Effects of motivational interviewing
intervention on self-management, psychological and glycemic outcomes in type 2
diabetes: a randomized controlled trial. International journal of nursing studies, 49(6),
637-644.
Clarke, S. F., & Foster, J. R. (2012). A history of blood glucose meters and their role in self-
monitoring of diabetes mellitus. British journal of biomedical science, 69(2), 83.
Das, S. L., Singh, P. P., Phillips, A. R., Murphy, R., Windsor, J. A., & Petrov, M. S. (2013).
Newly diagnosed diabetes mellitus after acute pancreatitis: a systematic review and meta-
analysis. Gut, gutjnl-2013.
Davies, M. J., Gagliardino, J. J., Gray, L. J., Khunti, K., Mohan, V., & Hughes, R. (2013). Real‐
world factors affecting adherence to insulin therapy in patients with Type 1 or Type 2
diabetes mellitus: a systematic review. Diabetic Medicine, 30(5), 512-524.

10PICO QUESTION
Dorresteijn, J. A., & Valk, G. D. (2012). Patient education for preventing diabetic foot
ulceration. Diabetes/metabolism research and reviews, 28(S1), 101-106.
Evert, A. B., Boucher, J. L., Cypress, M., Dunbar, S. A., Franz, M. J., Mayer-Davis, E. J., ... &
Yancy, W. S. (2014). Nutrition therapy recommendations for the management of adults
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Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., ... & McLaughlin, S.
(2012). National standards for diabetes self-management education and support. The
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Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-
centered approach. Position statement of the American Diabetes Association (ADA) and
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Mayberry, L. S., & Osborn, C. Y. (2012). Family support, medication adherence, and glycemic
control among adults with type 2 diabetes. Diabetes care, 35(6), 1239-1245.

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Peyrot, M., Barnett, A. H., Meneghini, L. F., & Schumm‐Draeger, P. M. (2012). Insulin
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Physicians in Insulin Therapy study. Diabetic Medicine, 29(5), 682-689.
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