Type 2 Diabetes Prevention: Perspectives of Nurses and GPs

This research proposal, conducted for the HLN707 Research Methods in Health course at Queensland University of Technology, investigates primary and secondary prevention strategies for type 2 diabetes mellitus from the perspective of nursing staff and general practitioners in Australia. The study aims to determine their perceptions on the identification and management of type 2 diabetes among at-risk individuals. A qualitative research design will be employed, utilizing focus groups with 30 participants from three hospitals. The research explores the role of nurses and GPs in early detection, lifestyle interventions, and pharmacological treatments, considering ethical implications and a detailed timeline. The proposal addresses the background, justification, research objectives, methodology, expected outcomes, and dissemination plan, including potential gaps in the research such as the exclusion of patient perspectives. The findings will be disseminated through various channels to healthcare workers and the target population.

Running head: PART B
Research proposal
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Name of the University
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Author Note
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Name- Student Number-
1. Research title
What primary and secondary prevention strategies can be implemented for type 2 diabetes
mellitus, a chronic disorder: perspective of nursing staff and general practitioners?
2. Research investigators
3. Summary of research plan
Background- Early prevention of the chronic disease diabetes is possible with the
implementation of appropriate pharmacological and lifestyle interventions among
individuals, who are considered to be at an increased likelihood of suffering from the
condition. Hence, primary care would be the valid setting for the research to be conducted.
Hypothesis- General Practitioners and nurses can help in early prevention of type 2
diabetes by implementing pharmacological and lifestyle interventions.
Aim- To determine the perceptions of general practitioners and nurses on the
identification and management of type 2 diabetes among people who are at risk
Research design- Qualitative study will comprise of focus groups as the data collection
method, followed by analysis of responses into themes.
4. Background and justification for research
Statistical reports suggest that an estimated 6% Australians that accounts for 1.2 million
people, aged more than 18 years suffered from diabetes in 2014-2015. There
wereapproximately 16,400 deaths in Australia in 2015 due to diabetes mellitus, with more
than half of them (55%) occurring due to type 2 diabetes (Australian Government, 2018).
Furthermore, death due to type 2 diabetes and rates of hospitalisation have been found to be
twice as great in rural regions, when compared to theurban areas. There is mounting evidence
that has associated socioeconomic disadvantage with an increase in vulnerability to develop
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diabetes, its prevalence, hospitalisation, and subsequent death rates (Saydah, Imperatore &
Beckles, 2013). Furthermore, there were approximately 1 million hospitalisations in the year
2015-2016 due to diabetes alone. This provides adequate evidence for justifying the rationale
behind focusing the research question on early detection and prevention of the chronic
disorder.
In the words of Yates et al. (2014) impaired tolerance of glucose and problems in fasting
glycaemia have been identified as major precursors that act as indicators for people who are
assumed to be at an augmented risk of acquiring type 2 diabetes mellitus.This impairment in
glucose tolerance (IGT) is usually defined in the form of a transition phase that fluctuates
between normal tolerance of glucose and diabetes mellitus, and is commonly referred to as
pre-diabetes. There is mounting evidence from clinical trials that focus on lifestyle
interventions that obese persons having impaired glucose tolerance have reported successful
prevention of their transition to type 2 diabetes mellitus, or a delay in the development of
their symptoms (Yoon, Kwok & Magkidis, 2013). This early management of the chronic
condition has usually been brought about by increased adherence to physical activity, and
dietary modifications that have resulted a subsequent weight loss. Furthermore, scholarly
literature by Yang et al. (2014) has also elaborated on the benefits exerted by
pharmacological intervention such as, acarbose and/or metformin.
The findings were further supported by the Diabetes Prevention Program that was
successful in establishing a correlation between amplified physical activity, metformin
therapy and a momentous lessening in the number of people who had impaired glucose
tolerance (Diabetes Prevention Program Research Group, 2015). Other evidences are also in
accordance to the fact that multifaceted lifestyle interventions that comprise of exercise,
dietary alterations, smoking cessation, counselling, and behavioural modifications have
proved beneficial in averting or delaying the onset of diabetes among people who have been
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detected to be at an increased risk for the chronic disorder (Gong et al., 2015). Lifestyle
interventions have also been found to exert direct benefits in neuropathy and severe
nephropathy (Dunkley et al., 2014).
People with diabetes have also been benefited from diabetes education that promotes
awareness on the disease, and its treatment regimen. It has also been found that good
nutritional intake and regular exercise will help in achieving a healthy body weight, thus
facilitating the management of the blood glucose levels in permissible limits. The long term
sustainability of the diabetes prevention procedures have also been found beneficial in
controlling high blood pressure, a risk factor for type 2 diabetes (Look AHEAD Research
Group, 2013).
On the other hand, there is enough evidence to explain the mechanism of action of the
anti-diabetic medications on the blood glucose levels. These pharmacological interventions
have been found to keep the blood sugar levels in normal ranges by increasing the uptake of
glucose from the peripheral cells, including the skeletal muscles (Pernicova & Korbonits,
2014). According to Rojas and Gomes (2013) metformin has also been established as the
mainstay treatment for type 2 diabetes where its initial prescription, along with compliance to
lifestyle interventions have been found to reduce the blood glucose levels, thus preventing
impaired glucose tolerance. Research evidences have also suggested that general
practitioners, although aware of the impaired glucose tolerance, often demonstrate a failure in
understandingtheimplication, in relation to risks for coronary heart illness and following
diabetes. This formed the basis for the research design.
5. Research aim
To determine the steps that can be taken for preventing type 2 diabetes mellitus, a chronic
disorder, by taking into account the perspective of nursing staff and general practitioners.
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The PICO framework refers to a technique that is primarily used in evidence based
practice for framing and answering a clinical question. However, in this research, since there
was no particular intervention, the PICO framework was not used. Hence, the PS format that
examines questions associated to understanding an issue was used in this regard.
P (Population) Nursing staff and general practitioners
S (Situation) Early detection and prevention of type 2
diabetes
Table 1- Research question
5.1 Research objectives
 What do nursing staff and general practitioners know about early detection of
individuals who are at an increased risk of type 2 diabetes onset?
 What resources and guidance must be provided for helping nursing staff and general
practitioners play their role in primary prevention of the condition?
6. Research design
The research will be based on a qualitative approach that will be mainly exploratory in
nature and will allow gaining a sound understanding of the underlying opinions, reasons, and
motivations behind the phenomenon that is being investigated (Lewis, 2015). Hence, this
research design will facilitate gaining a deeper insight into the problem of early detection and
prevention of type 2 diabetes. A total of 30 nursing staff and general practitioners, working
across three hospitals in the district will be asked to participate in the focus group. They will
be sent sealed envelope that will contain detailed information on the purpose and potential
benefits of the research that is intended to be conducted.
The sample selection will be based on convenience sampling, followed by selection of a
location that can be easily accessed by all participants. Financial reimbursement of
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approximate will be paid to each participant 150 AUD, for attending the focus group, in place
of caring for the patients. Focus groups will form the primary data collection method, where
each team will be comprised of five members. The focus group will allow collection of
responses from a planned discussion that will elicit the thoughts and perceptions of the
participants on the research question, and will be conducted over two months.
Primary reason for using focus group as the data collection procedure is for discovering
how the respondents feel and think about the topic, and adding a certain human dimension to
the associated impersonal data (Cleary, Horsfall & Hayter, 2014). This will also offer broader
range of information and create provisions for seeking clarification. The lead facilitator will
be involved in directing the questions and prompting the participants to provide responses
(Fusch & Ness, 2015). This will be followed by recording the responses, and taking notes on
the verbal and non-verbal cues such as, emotive elements and body language. The responses
will be transcribed verbatim, and the emergent patterns of responses will be categorised into
themes and sub-themes.
7. Ethical implications
Ethical approval will be taken from the university Human Research Ethics Committee.
Informed consent will be taken from all participants, prior to beginning the data collection
procedure. They will also be allowed to withdraw or refuse participation at any point of time.
8. Research timeline
Research
timeline
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Backgroun
d reading
Developing
research
question
Deciding
the
background
aims and
objective
Obtaining
ethical
approval
Focus
group
Analysis
Drawing
conclusion
Writing the
findings
Disseminati
on
Table 2- Timeline for research
9. Research outcomes
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Contrasting views might be prevalent among the nurses and the general practitioners
regarding the steps that they should take for early detection and prevention of type 2 diabetes.
Although the participants are expected to emphasise on the benefits that administration of
lifestyle interventions, in combination with pharmacological therapies might exert on the at-
risk population, they might cite lack of available resources as a major barrier that prevents
them from adorning their role in primary care facilities. Low patient motivation and need for
diabetes education campaigns are also expected to be discussed in the responses.
10. Dissemination of findings
 The findings will be disseminated via podcasts, blogs, conferences, leaflets and
pamphlets.
 The primary healthcare workers and target population that has been identified at an
increased risk of type 2 diabetes onset will be disseminated the findings.
 The hospital authorities and local government officials will also be made aware on the
results since they play an important role in making resources available that are
necessary for disease prevention and early management.
Research gaps:
The objective designed for the research proposal had focused entirely on the
perspectives of the care providers or the health care professionals for the prevention
strategies. The patient perspective on the feasible primary and secondary prevention
strategies were not included in the focus of the research which can be considered a huge gap
for the research to be inclusive. Although, due to time and resource availability restrain, for
this research we are will only be focusing on the perspectives of the nurses and the general
practitioners.
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References
Australian Government. (2018). Diabetes snapshot. Retrieved from
https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-
australians-have-diabetes.
Cleary, M., Horsfall, J., & Hayter, M. (2014). Data collection and sampling in qualitative
research: does size matter?. Journal of advanced nursing, 70(3), 473-475.
Diabetes Prevention Program Research Group. (2015). Long-term effects of lifestyle
intervention or metformin on diabetes development and microvascular complications
over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. The
lancet Diabetes & endocrinology, 3(11), 866-875.
Dunkley, A. J., Bodicoat, D. H., Greaves, C. J., Russell, C., Yates, T., Davies, M. J., &
Khunti, K. (2014). Diabetes prevention in the real world: effectiveness of pragmatic
lifestyle interventions for the prevention of type 2 diabetes and of the impact of
adherence to guideline recommendations: a systematic review and meta-
analysis. Diabetes care, 37(4), 922-933.
Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative
research. The qualitative report, 20(9), 1408-1416.
Gong, Q. H., Kang, J. F., Ying, Y. Y., Li, H., Zhang, X. H., Wu, Y. H., & Xu, G. Z. (2015).
Lifestyle interventions for adults with impaired glucose tolerance: a systematic review
and meta-analysis of the effects on glycemic control. Internal Medicine, 54(3), 303-
310.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five
approaches. Health promotion practice, 16(4), 473-475.
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Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle
intervention in type 2 diabetes. New England journal of medicine, 369(2), 145-154.
Pernicova, I., & Korbonits, M. (2014). Metformin—mode of action and clinical implications
for diabetes and cancer. Nature Reviews Endocrinology, 10(3), 143.
Racgp.org.au (2018). RACGP – Obesity Prevention guidelines. [Online]. Retrieved from
https://www.racgp.org.au/publications/goodpractice/201703/overweight-and-obesity
[Accessed on 4th Nov].
Rojas, L. B. A., & Gomes, M. B. (2013). Metformin: an old but still the best treatment for
type 2 diabetes. Diabetology & metabolic syndrome, 5(1), 6.
Saydah, S. H., Imperatore, G., & Beckles, G. L. (2013). Socioeconomic status and mortality:
contribution of health care access and psychological distress among US adults with
diagnosed diabetes. Diabetes care, 36(1), 49-55.
Yang, W., Liu, J., Shan, Z., Tian, H., Zhou, Z., Ji, Q., ... & Xu, Y. (2014). Acarbose
compared with metformin as initial therapy in patients with newly diagnosed type 2
diabetes: an open-label, non-inferiority randomised trial. The Lancet Diabetes &
Endocrinology, 2(1), 46-55.
Yates, T., Haffner, S. M., Schulte, P. J., Thomas, L., Huffman, K. M., Bales, C. W., ... &
Tuomilehto, J. (2014). Association between change in daily ambulatory activity and
cardiovascular events in people with impaired glucose tolerance (NAVIGATOR
trial): a cohort analysis. The Lancet, 383(9922), 1059-1066.
Yoon, U., Kwok, L. L., & Magkidis, A. (2013). Efficacy of lifestyle interventions in reducing
diabetes incidence in patients with impaired glucose tolerance: a systematic review of
randomized controlled trials. Metabolism, 62(2), 303-314.
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