Glycemic Control in Adults with Diabetes: Research, Review, and Future

This report investigates the impact of exercise on glycemic control in adults with type 2 diabetes. It begins with a PICOT research question focusing on the effects of regular aerobic exercise. The report then evaluates a study by Motahari-Tabari et al. (2015), which examined the impact of aerobic exercise on insulin resistance. The research topic emphasizes the importance of glycemic control in managing diabetes, a leading cause of mortality and disability. A literature review synthesizes findings from various studies, highlighting the role of nurses and healthcare providers in promoting non-pharmacological interventions like exercise. The review discusses the effectiveness of different exercise types, the importance of exercise intensity, and the physiological impacts of exercise on diabetic patients. Finally, the report recommends future research, proposing a randomized study to compare the benefits of various exercises on glycemic control, with a large sample size to ensure reproducible outcomes. The report concludes with a comprehensive list of references and an annotated bibliography of the three articles reviewed.

Running head: GLYCEMIC CONTROL IN ADULTS WITH DIABETES 1
Glycemic Control in Adults with Diabetes
Student’s Name
University Affiliation

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 2
Table of Contents
PICOT research question.................................................................................................................2
Evaluation of research.....................................................................................................................2
Research Topic................................................................................................................................3
Literature Review............................................................................................................................4
Recommendation Future Research..................................................................................................6
References........................................................................................................................................8
Annotated bibliography of the three articles...................................................................................9

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 3
Glycemic Control in Adults with Diabetes
PICOT research question
In adults with type 2 diabetes, does regular aerobic exercise improve glycemic control compared
to no exercise in a year?
Population (P) Adults with type 2 diabetes
Intervention (I) regular aerobic exercise
Comparison (C) No exercise
Outcome (O) Improve glycemic control
Time (T) 1 year
The research question was developed because the incidence of type II diabetes in adults is
high and glycemic control is an important priority for patients with diabetes. In addition, the
research question considered a cost-effective intervention that can be monitored on an ongoing
basis. Sufficient time is needed to determine the effectiveness of an intervention, and that is why
the proposed intervention would be monitored for one year.
Evaluation of research
One article: Motahari-Tabari et al. (2015)
In this study, the authors used a randomised clinical trial to determine the impact of
aerobic exercise on insulin resistance among persons with type 2 diabetes. The research is
motivated by the finding that approaches to reduce insulin resistance might be combined with
other effective treatments. A population sample of 53 women with type II diabetes was recruited
for the research and categorized into two groups. The groups included 27 women in exercise
training and 26 females in the control group. Importantly, the women in the exercise group were
exposed to an 8-week aerobic exercise to evaluate insulin resistance. The exercises involved
flexibility and stretching for ten minutes, 30-minute walk with a 60 per cent rise in heart rate and

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 4
10-minute stretch in a while seated. All the participants in the exercise group performed these
exercises three times a week for eight weeks. Further, Homeostasis Model Assessment of Insulin
Resistance (HOMA-IR) is utilized to examine insulin resistance in the sample population. Based
on the results, aerobic exercises decreased blood glucose in the 27 women substantially. In
essence, the results imply that aerobic exercises are effective in glycemic control. Ethics were
observed in this study since there was informed consent. All the participants were first briefed
about the study process and interventions.
Research Topic
The research topic is the impact of exercise on glycemic control in patients/adults with
type II diabetes. Importantly, diabetes is among the leading causes of mortality and disability
around the country. As of 2016, about one in every 1,500 Australians was taking insulin to
manage type II diabetes (AIHW, 2018). Between 2009 and 2014, approximately 152,634 deaths
were recorded in the people diagnosed with type II diabetes (AIHW, 2017). Importantly,
healthcare professionals should focus on the medical areas of priority to improve the quality of
life for the general population. In this study, exercise has been chosen as the intervention because
it is practical and simple to implement in the community to improve the health outcomes of the
adults with chronic conditions. Besides, exercise is an effective care that increases the
engagement of the persons with diabetes. In terms of practicality, exercise intervention is
practical because it creates a supportive system, an information sharing environment and it is
simple to measure the success after a given period. Besides, the proposed health intervention in
this study can be tailored for priority groups such as the indigenous Australians in the rural areas.
Exercises are a means to promote health, which creates a healthier population in the community.
The topic is ideal because the intervention would reduce the risk of disability and mortality for

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 5
adults diagnosed with type II diabetes across Australia. Essentially, the topic is directly related to
enhancing the health outcomes for persons with type II diabetes through effective and cost-
effective glycemic control.
Literature Review
The research evidence suggests that nurses and other healthcare providers can play a
great role to improve the outcomes of persons with chronic conditions. Most important, the
literature points towards the adoption of non-pharmacological methods including exercises in the
treatment, management and prevention of diabetes. Nursing practice needs to advocate for
regular exercises for patients diagnosed with type II diabetes. Najafipour et al. (2017) found that
regular exercise training has a substantial impact on haemoglobin A1c (HbA1c). Nevertheless,
health care professionals should determine how often or regular patients with type II diabetes
should be exposed to exercise training. In an effort to answer this question, Hamasaki (2016)
asserts that daily physical activity improved metabolism that is essential in diabetic management.
Motahari-Tabari et al. (2015) developed an intervention whereby the participants engaged in
physical activity three times a day. The findings indicate that nurses should focus on developing
a long-term exercise intervention that fosters daily participation. Nurses can design this treatment
plan and implement it in health care settings and community settings. Rossen et al. (2015),
develops and compares the efficacy of different physical activities in primary care settings. In a
randomised study, the participants are randomly allocated to a control group, a pedometer group
or a multi-component intervention group and followed for up to 24 hours (Rossen et al., 2015).
Recent research has found that the benefits of exercises in insulin sensitivity persist for between
48 and 72 hours and might even be reported beyond the 72 hours (Way, Hackett, Baker &
Johnson, 2016).

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 6
Nurses should also determine the most effective exercises for adults diagnosed with type
II diabetes. Even though there are many exercise training that can be administered to patients
with chronic conditions, certain exercise might be more effective than others. Motahari-Tabari et
al. (2015) designed a study to establish the effectiveness of aerobic exercises. In the study, the
authors found that aerobic exercises help to lower plasma glucose meaning that these exercises
are effective. On the other hand, circuit resistance training has also been found to be produce
positive outcomes in glycemic control in women diagnosed with type 2 diabetes (Shabani,
Nazari, Dalili & Rad, 2015). Circuit resistance training involves a combination of physical
exercises such as warming up, cooling and repetition of different tests (Shabani et al., 2015).
Based on these findings, it is evident that different forms of exercises can be implemented in the
management of type II diabetes in adults.
Nevertheless, health care providers should implement exercises that are suitable for the
target population meaning that they should use a patient-centred care approach. The designing of
custom exercise is supported by the fact that the ideal technique for enhancing glucose control
and minimising cardiometabolic risk in diabetic patients not been established (Francois & Little,
2015). Other types of exercises that have been proposed for patients with type II diabetes include
endurance-type exercise, joba riding and yoga classes (Thent, Das & Henry, 2013). Healthcare
providers should acknowledge that the intensity of exercise is an important predictor of the
outcome. Therefore, this fact should guide them when designing exercise therapy in primary care
settings, community settings or aged care facilities. The most important implication is that they
can design exercise therapy for active and weak patients. Francois and Little (2015), argues that
the intensity, type of exercise, and duration play a fundamental role in the level of benefits
achieved. Some patients with type 2 diabetes might be physically weak to perform the prescribed

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 7
intensity of physical activity (Hamasaki, 2016). Despite the condition of the patient with type II
diabetes, physical activity should be designed to fit into their daily life without increasing a
substantial burden.
As nurses design exercise therapy for patients with diabetes, they should understand how
exercises impact the patient. Exercises foster a rise in bioavailability of nitric oxide and result in
a decline in post-exercise blood pressure (Asano, 2014). In addition, exercise lead to metabolic
stress that increases carbohydrate oxidation, increase fat oxidation and enhance glucose tolerance
(Asano, 2014). During exercises, insulin sensitivity increases and leads to a decline in glycemia
volumes between 2 and 72 hours (Asano, 2014). Similarly, Francois and Little (2015) assert that
exercises are ideal for persons with diabetes. These authors argue that exercise offers extra health
benefits specifically for blood glucose control and act as a vital intervention in the prevention
and treatment of diabetes and the adverse events linked to type II diabetes (Francois & Little,
2015).
Based on the literature review, nurses should encourage adults with diabetes to adopt a
lifestyle change whereby physical activity is a part of the daily activities. Asif (2014)
acknowledges that changing lifestyle to include activities such as walking can help to prevent
and treat diabetes. In essence, recent literature has found that exercises have many benefits for
adults with type II diabetes.
Recommendation Future Research
Future research in this area should establish whether different exercises result in similar
benefits for adults with type 2 diabetes. Since different exercises have been proposed, it is
essential to determine whether the patients will attain the same benefits in the long term in terms
of glycemic control. A randomised study should be designed for this future research whereby

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 8
patients with type II diabetes are randomly recruited. In this case, a large sample size of about
200 adults would help to deliver reproducible outcomes. The patients should be divided into four
groups and each exposed to a different kind of exercises including aerobic exercise, circuit
resistance training, yoga and joba riding. Before the interventions are initiated, all participants
should be informed about the risks, mode of physical activity and the expected outcomes. At this
point, patients who want to quit the research should be given a chance and not restrained. The
200 patients should be subjected to similar measures to determine how their physical activity
affects glycemic control. In case some patients are unable to continue with the assigned physical
activity, they should be discontinued. Essentially, this research will be fundamental for nursing
practice because it will determine whether different exercises have similar benefits.

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 9
References
AIHW. (2017). Deaths among people with diabetes in Australia, 2009-2014. Australian Institute
of Health and Welfare. Retrieved from https://www.aihw.gov.au/getmedia/c164ec7c-
fc66-4991-8e53-62eba274ead4/aihw-cvd-79.pdf.aspx?inline=true
AIHW. (2018). Incidence of insulin-treated diabetes in Australia. Australian Institute of Health
and Welfare. Retrieved from https://www.aihw.gov.au/reports/diabetes/incidence-insulin-
treated-diabetes-australia-2016/contents/introduction
Asano, R. Y., Sales, M. M., Browne, R. A. V., Moraes, J. F. V. N., Júnior, H. J. C., Moraes, M.
R., & Simões, H. G. (2014). Acute effects of physical exercise in type 2 diabetes: a
review. World journal of diabetes, 5(5), 659-665. Doi: 10.4239/wjd.v5.i5.659.
Asif, M. (2014). The prevention and control the type-2 diabetes by changing lifestyle and dietary
pattern. Journal of education and health promotion, 3, 1. Doi: 10.4103/2277-
9531.127541.
Francois, M. E., & Little, J. P. (2015). Effectiveness and safety of high-intensity interval training
in patients with type 2 diabetes. Diabetes Spectrum, 28(1), 39-44. Doi:
10.2337/diaspect.28.1.39.
Hamasaki, H. (2016). Daily physical activity and type 2 diabetes: a review. World journal of
diabetes, 7(12), 243-251. Doi: 10.4239/wjd.v7.i12.243.
Motahari-Tabari, N., Shirvani, M. A., Shirzad-e-Ahoodashty, M., Yousefi-Abdolmaleki, E.,
&Teimourzadeh, M. (2015). The effect of 8 weeks aerobic exercise on insulin resistance
in type 2 diabetes: a randomized clinical trial. Global journal of health science, 7(1), 115-
121. Doi: 10.5539/gjhs.v7n1p115.

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 10
Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N. M., ... &
Sadra, V. (2017). Effect of regular exercise training on changes in HbA1c, BMI and
VO2max among patients with type 2 diabetes mellitus: an 8-year trial. BMJ Open
Diabetes Research and Care, 5(1), e000414. Doi: 10.1136/bmjdrc-2017-000414.
Rossen, J., Yngve, A., Hagströmer, M., Brismar, K., Ainsworth, B. E., Iskull, C., ... &
Johansson, U. B. (2015). Physical activity promotion in the primary care setting in pre-
and type 2 diabetes-the Sophia step study, an RCT. BMC public health, 15(1), 647. Doi:
10.1186/s12889-015-1941-9.
Shabani, R., Nazari, M., Dalili, S., & Rad, A. H. (2015).Effect of circuit resistance training on
glycemic control of females with diabetes Type II. International journal of preventive
medicine, 6, 34. Doi: 10.4103/2008-7802.154923.
Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of exercise in the management of diabetes
mellitus: the global scenario. PloS one, 8(11), e80436. Doi:
10.1371/journal.pone.0080436.
Way, K. L., Hackett, D. A., Baker, M. K., & Johnson, N. A. (2016). The effect of regular
exercise on insulin sensitivity in type 2 diabetes mellitus: a systematic review and meta-
analysis. Diabetes & metabolism journal, 40(4), 253-271. Doi:
10.4093/dmj.2016.40.4.253.
Annotated bibliography of the three articles
1. Najafipour et al. (2017)
This article determines the impacts of regular exercises on biological indicators for
individuals with type II diabetes. 65 patients aged between 33 and 69 years were included in the
study and divided into 35 females in experiment and 30 in control groups. 30 women completed

GLYCEMIC CONTROL IN ADULTS WITH DIABETES 11
the 8-year program, which involved aerobic exercises and their biological indicators were
measured. The experiment group realised a significant reduction in BMI and HbA1c.
2. Motahari-Tabari et al. (2015)
This article uses a randomised method to determine the impact of aerobic exercise on
insulin resistance in patients diagnosed with type II diabetes. 27 diabetic women are exposed to
aerobic exercise for 8 weeks, and their plasma glucose is accessed. These women were
compared to a control group of 26 women. The results indicate that the 27 women experienced a
significant decline in plasma glucose.
3. Shabani et al. (2015)
The authors designed a study to determine the impact of circuit resistance training on
controlling glycemic levels in women with diabetes. In this article, twenty obese and overweight
females diagnosed with type 2 diabetes were randomly recruited in this study and subjected to
the training for three days per week for three months. The results show that the women
experienced a significant change in HbA1c.