EBP Analysis: Managing Type 2 Diabetes and Peripheral Neuropathy

This case study explores the application of evidence-based nursing in managing a patient with uncontrolled type 2 diabetes and peripheral neuropathy. It critically evaluates and compares two EBP resources: the American Diabetes Association's 'Standards of Medical Care in Diabetes-2017' and the American Academy of Family Physicians' (AAFP) 'Clinical Practice Guidelines.' The analysis highlights the strengths and limitations of each resource, focusing on their utility in guiding lifestyle modifications, pharmacological interventions, and patient education. The study emphasizes the importance of integrating research evidence with clinical experience to improve patient outcomes and promote adherence to recommended care plans, especially in diabetes self-management and neuropathy management. The comparison underscores the necessity of carefully selecting and validating EBP resources based on individual patient needs and healthcare goals.

Running head: EVIDENCE BASED NURSING
Evidence based nursing
Name of the student:
Name of the University:
Author’s note

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Introduction:
As the rate of diabetes is increasing dramatically, research evidence on the effective
management of the disease plays an major role in the prevention of long term complications.
Effective translation of research knowledge is the key to improve clinical care and effective
apply latest information to evaluate patient outcome and provide the best care to patient. Proper
evaluation of evidence based resource is also critical to plan the best care of patient (Afable &
Karingula, 2016). This report reviews the case study of a patient with uncontrolled type 2
diabetes and peripheral neuropathy and critically evaluates and compares two EBP resources that
could influence care provided to the client.
Comparison of two EBP resources:
The case study is related to a client with increasing pain on feet. She was diagnosed with
diabetes six months ago and diagnostic testing has revealed that patient is suffering from
uncontrolled type 2 diabetes, peripheral neuropathy and hyperlipidemia. Based on her current
symptoms, lifestyle modification and patient education is vital for her recovery. For the patient,
doing some research on diabetes management would help her to take better decision regarding
her health. As the patient is not aware of what is high level of evidence, comparison of two
papers can give idea about best resource for her care. The first EBP resource chosen for her
includes the ‘Standards of Medical Care in Diabetes-2017’ developed by American Diabetes
Association (2017) and the second EBP resource includes ‘Clinical practice guidelines’
developed by AAFP (2016). The difference between the two guidelines is that the first resource
gives full information on diabetes prevalence and different types of secondary and tertiary
preventive steps to prevent the disorder. However, AAFP (2016) focus only on evaluation oral

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pharmacologic intervention for people with diabetes. Hence, by looking at this paper,
information in all areas related to diabetes complications can be obtained. In contrast, the second
resource gives information only on oral pharmacologic treatment of type 2 diabetes in adults.
Therefore, the first article has a wide focus and the second resource has a narrow focus.
As the first resource by American Diabetes Association (2017) gives detailed information
on different types of management strategies for diabetes, the paper can be utilized to plan proper
care for the client. As the patient in the case study has been recommended lifestyle modification
intervention like diet control and regular exercise to control diabetes, the lifestyle management
section of the paper can be explores to determine the significance of lifestyle modification
intervention. The significance of the information in this section is that it gives detailed insight
into the importance of lifestyle management for diabetes self-management support. The
credibility of the work has been enhanced by giving evidence on the benefits of this intervention
(Noble & Smith, 2015). Furthermore, the evidence can be easily applied as different aspects of
lifestyle management such as nutrition therapy and physical activity has been discussed
separately making it easy for patients to follow. However, the limitation found in the paper is
that it has not given details regarding the method by which quality of the evidence was
determines thus affecting the trustworthiness of the research paper. In contrast, the second EBP
resource although having narrow focus is considered more useful as systematic review of
randomized controlled trials and observational studies was done to evaluate the impact of
pharmacologic management on patient (AAFP, 2016). Elwood (2017) argues that critically
appraising the best evidence is critical to integrate it in clinical experience and patient values.
Systematically assessing reliability, value and relevance is essential to direct clinical decision
making.

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The two EBP resources are also considered useful to provide direction to patient
regarding the significance of lifestyle modification intervention and pharmacological treatment.
The difference in the appraisal method of the two resources is that the first evidence has used
evidence rating scale to rate each evidences and the second has used totality of the evidence as a
criteria to rate the quality of the evidence. The review of recommendations mentioned in each
paper can give idea about the utility of the evidence on the care plan for patient. For example, the
patient in the case study has been recommended high fiber and low fat diet. The guidelines by
ADA (2017) mentions that diet choice can depend on patient’s health status and preferences. The
guideline shows that diabetes self-management education sustains skills and behaviour needed
for ongoing self-management. Hence, to support patient in adhering to the recommended care
plan, the details about nutrition therapy in the first resource will aid patient in understanding the
benefits of following specific diet patterns. A research by Franz, Boucher and Evert (2014)
investigated about the effectiveness of ADA’s recommendation of diabetes nutrition therapy and
has revealed that having nutrient dense and high fiber food is critical for patient with diabetes.
Strong evidence was also provided rgerading the effectiveness of nutrition therapy for continuum
of diabetes management. Hence, clarifying the information present in the first resource with
current research paper further confirms the effectiveness and reliability of the resource for the
patient. In addition, the second resource suggests that metformin should be provided to patient
with type 2 diabetes to achieve glycemic control. Patient in the case study has also been provided
Metformin and the review of second resource clarifies the rational for giving this medication thus
leading to patient’s adherence with the therapy. The guidelines also reported about several high
quality evidences that support the superiority of Metformin combination therapy in reducing to

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HbA1c level compared to metformin monotherapy. Hence, the evidence can increase
understanding of patient regarding the reason for being prescribed combination medications.
Another difference found in the two EBP resources is that the first guideline focus on
giving information regarding different options for diabetes self-management along with support
from evidence. However, the second aims to increase the credibility of the recommendation by
giving full details regarding the effectiveness of single oral pharmacology intervention by
comparison with various other literatures. Therefore, the second information can help to clarify
regarding the credibility of metformin combination therapy for treatment of diabetes. Using this
evidence, all doubts related to effectiveness of pharmacologic treatment is cleared. However,
applicability of the first resource is low as it needs evaluation from other research papers.
Despite differences, the two resources can give guidance to patients regarding the way to
engage in diabetes self-management. First evidence gives clear direction on all possible
interventions to manage diabetes. However, the second resource only focus on proving that
combination metformin therapy is more effective in treating diabetes. Another major problem for
patient in the case study was diabetes neuropathy. In response to this issue, the patient has been
advised to do 150 minutes per week of moderate intensity exercise and wear proper fitting foot
wear. The first resource by ADA (2017) also gives evidence that proper footwear and 150
min/week of moderate exercise improve outcomes in patient with neuropathy. The patient has
been referred to a podiatrist and this is important as part of preventative treatment to enhance
education on foot self-care (Pop-Busui et al., 2017). A systematic review on diabetes self-
management education has revealed that engagement in diabetes self-management education can
significantly lead to reduction in A1C level. Hence, based on self-management goals, the two

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EBP resources can be utilized to influence care plan of patient and encourage her to adhere to the
recommended intervention.
Conclusion
The comparison of the two EBP resources gives the insight that guidelines on diabetes
provides the right direction to engage in diabetes self-management. However, each guideline
may differ on the method used to validate their recommendations. The two EBP resources had
different focus areas and their evaluation methods for each interventions differed accordingly.
Hence, patients or health care professionals willing to utilize EBP resources for diabetes
management must identify their goal in referring to guidelines first and then compare them with
other research work to determine whether they can use the information for their individualized
care plan or not.

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References:
AAFP. (2016). Clinical Practice Guidelines. Retrieved from:
https://www.aafp.org/patient-care/clinical-recommendations/all/type2-diabetes.html
Afable, A., & Karingula, N. S. (2016). Evidence based review of type 2 diabetes prevention and
management in low and middle income countries. World journal of diabetes, 7(10), 209.
American Diabetes Association (2017). Retrieved from: Standards of Medical Care in Diabetes
2017.
http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/
DC_40_S1_final.pdf
Elwood, M. (2017). Critical appraisal of epidemiological studies and clinical trials. Oxford
University Press.
Franz, M. J., Boucher, J. L., & Evert, A. B. (2014). Evidence-based diabetes nutrition therapy
recommendations are effective: the key is individualization. Diabetes, metabolic
syndrome and obesity: targets and therapy, 7, 65.
Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative research. Evidence-
Based Nursing, ebnurs-2015.
Pop-Busui, R., Boulton, A. J., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., ... & Ziegler,
D. (2017). Diabetic neuropathy: a position statement by the American Diabetes
Association. Diabetes care, 40(1), 136-154.

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