Evidence-Based Nursing Practice Report: Clinical Issue Analysis

This report delves into evidence-based nursing practice, focusing on the clinical issue of type 2 Diabetes Mellitus (T2DM) in Australia. It begins with an identification of the clinical problem, highlighting the increasing prevalence of T2DM and its associated comorbidities. The report then formulates a research question concerning the effectiveness of lifestyle interventions versus insulin injections in managing blood glucose levels. A comprehensive search strategy is outlined, and relevant articles are selected and critically appraised using the JBI checklist. The synthesis of findings reveals that lifestyle interventions, including diet and exercise, are more effective in managing T2DM and reducing associated risk factors compared to pharmacological interventions like metformin. The highest level of evidence is identified as systematic reviews and meta-analyses. The report concludes with a discussion of the implications for evidence-based nursing practice, emphasizing the importance of lifestyle interventions in the effective management of T2DM and improved patient outcomes. The report also includes a detailed appendix with search strategies, article lists, and a PRISMA chart.

Running head: NURSING
Evidence Based Nursing Report
Name of the Student
Name of the University
Author Note

NURSING
Table of Contents
Part 1..........................................................................................................................................3
Identification of the Clinical Issue.........................................................................................3
Summarising the evidence based...........................................................................................3
Justification for the choice of topic........................................................................................4
Research Question..................................................................................................................4
Search Strategy.......................................................................................................................4
List of Articles........................................................................................................................4
Rationale for the choice of the paper.....................................................................................5
Part 2..........................................................................................................................................6
Synthesis of Findings.............................................................................................................6
Identification of highest level of evidence.............................................................................8
Critical appraisal tool.................................................................................................................8
Critical appraisal....................................................................................................................8
Answer 1............................................................................................................................8
Answer 2............................................................................................................................9
Answer 3............................................................................................................................9
Answer 4..........................................................................................................................10
Answer 5..........................................................................................................................10
Answer 6..........................................................................................................................10
Answer 7..........................................................................................................................10
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Answer 8..........................................................................................................................11
Answer 9..........................................................................................................................11
Answer 10........................................................................................................................11
Answer 11........................................................................................................................11
Appendix 1...............................................................................................................................12
Search Strategy.....................................................................................................................12
Appendix 2...............................................................................................................................16
The final list of articles........................................................................................................16
Appendix 3...............................................................................................................................17
PRISMA Chart.....................................................................................................................17
Appendix 4.............................................................................................................................0
References..................................................................................................................................8
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Part 1
Identification of the Clinical Issue
One of the local health need in Australia is increase in the rate of incidence and
prevalence of Type 2 Diabetes Mellitus (T2DM). According to Australian Institute of Health
and Welfare [AIHW] (2019), 1.2 million (6%) of the Australian adults who are above 18
years of age (2017-18) suffers from diabetes. T2DM is more common than T1DM and is the
principle causes of hospitalizations. People residing under poor socioeconomic disadvantage
group are principle victims of T2DM. The rate of incidence of T2DM has increased among
the adult Australian population by 3.3% since 2001. The percentage is higher in men than
women. The development of T2DM is associated with several co-morbidities like cardio-
vascular disease, renal complications, peripheral neuropathy and retinopathy. Nearly 2/3rds
of the Australian adults who are suffering from diabetes experiences heart attack every year
and it is estimated that in the upcoming year nearly 1100 and 3300 Australians will suffer
from diabetes-associated heart attack (Diabetes Australia, 2019). The medication
management doe for the diabetes management include injection of subcutaneous insulin in
order to lower the blood glucose concentration in the blood. Moreover, in addition to this, the
affected individuals might also require proper pharmacological interventions in order to
reduce the high blood pressure and high level of blood cholesterol for managing the co-
morbidities of diabetes.
Summarising the evidence based
However, in T2DM, the glucose in the blood is insulin resistant and insulin
administration fails to extract the desired results. The escalating rate of diabetes in Australia
is also indicating the need for change of the insulin therapy in Australia (Diabetes Australia,
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2019). According to the reports published by Diabetes Australia (2019), investigation of the
evidence-based care for the Australian suffering from the diabetic-foot ulcers might help in
saving of nearly $2.7 billion investment in the healthcare during the last five years.
Justification for the choice of topic
The non-modifiable risk factors for the development of diabetes include genetic pre-
disposition, age of the individual and family history. The modifiable risk factors behind the
development of diabetes include unhealthy lifestyle habits like obesity, sedentary life,
smoking and alcohol consumption (Australian Government Department of Health, 2016).
National Institute of Diabetes and Digestives, and Kidney Diseases (2019) stated that
modifications of the lifestyle factors could be helpful in reducing the severity and
vulnerability of developing T2DM.
Research Question
Thus the main clinical Questions include: What is the effectiveness of the lifestyle
interventions in reducing the blood glucose level of the individuals suffering from T2DM in
comparison to insulin injection
Population (P) Adults with T2DM and having high blood glucose level
Interventions (I) Healthy lifestyle interventions
Comparison © Insulin injection
Outcome (O) Reduced blood glucose level in blood
Search Strategy
Given in the appendix section (Appendix 1) for the CINHAL databases that was selected for
search of the articles
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List of Articles
Given in the appendix (Appendix 2)
Rationale for the choice of the paper
All the five selected articles focused on the effective management of the Type 2
Diabetes Mellitus. Out of the five articles, 3 articles focused in the relevance of the lifestyle
interventions on the diabetes management and two articles focused in the effectiveness of
insulin in T2DM. One of the selected articles is a meta-analysis, while one is systematic
review and meta-analysis; one is only meta-analysis. The remaining two articles include
cohort study and one is randomised control trial. The systematic review and meta-analysis are
more reliable than the single study because it helps in getting a retrospective overview of
more than one study and then framing of the final results based on the summative over-view.
LoBiondo-Wood and Haber (2017) are of the opinion that systematic review and meta-
analysis are helpful in framing evidence-based nursing practice. Randomised control trail are
selected because it they study is associated with low level of bias. Cohort study is a type of
longitudinal study that helps in the establishment of the risk factors and the health related
outcomes of the study.
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Part 2
Synthesis of Findings
The cohort study conducted by Kos et a. (2011) over 706 patients suffering from the
type 2 diabetes mellitus between the age group of 20 to 93 years with the BMI of 33.1 kg/m2
showed that the patients who are taking metformin have significantly low level of vitamin
B12 in comparison to the people who are not receiving metformin for the management of the
diabetes (P value < .0001). Metformin however didnot affected that vitamin reserve of the
body or inflicted any significant harm to the patients suffering from osteoporosis. The
metformin injection however, failed to regulated the blood glucose level among the T2DM
patients for long term use. This cohort study thus showed that the use of the metformin might
not be suitable in long term for the effective management of T2DM and is also associated
with harmful side-effects like increase in the level of vitamin B12 deficiency. The double
blinded randomised control trial conducted by Rosenstock et al. (2013) aimed towards
highlighting the effects of the sodium glucose transporter (SCLT2) inhibitor added to
metformin for 12 weeks over the patient suffering from T2DM. The study was conducted
over 495 patients with T2DM whose blood glucose level is inadequately controlled due to
lack of proper action of subcutaneous insulin injection. The analysis of the results of the trial
showed that empagliflozin when added along with metformin is well-tolerated among T2DM
patients however it resulted in the genital infection and also increase the tendency of
developing hypoglycaemia. Thus both the study selected to study the efficacy of metformin
(insulin) in T2DM management failed to provide a significant positive improvement in
T2DM management. Chen et al. (2015) conducted a meta-analysis in order to study the effect
of the lifestyle interventions in reducing the clinical risk factors and level of blood glucose
among T2DM patients. Meta-analysis was done over the RCTs study. A total of 16 studies
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were selected. The analysis of the results showed that proper observance of the lifestyle
interventions help in reducing the risks factors that increases the severity of developing
T2DM like high level of blood glucose and high body weight and cardiovascular disease.
Schellenberg Dryden, Vandermeer and Korownyk (2013) conducted systematic review and
meta-analysis in order to investigate the multifaceted lifestyle interventions in reducing the
metabolic risk factor for the development of type 2 diabetes and to reduce the abnormal
concentration of glucose. The systematic review and meta-analysis was conducted by two
separate reviewer and the papers were selected from the 5 different electronic databases from
1980 to 2013. Only randomised control trial were selected for the review. The analysis of the
review of the 9 RCTs showed that comprehensive lifestyle interventions help to decrease the
blood glucose level among T2DM patients and thus helping in effective management of
disease. Howells, Musaddaq, McKay and Majeed (2016) conducted a review by selecting 19
recent systematic reviews. The main of the study was to investigate the healthy lifestyle
intervention like the combined diet and physical activity for reducing the blood glucose level
among the patients with T2DM with more than 12 months of follow-up. The analysis showed
that the lifestyle interventions in long term is helpful in reducing blood glucose level in
comparison to the use of the metformin (insulin) for diabetes management.
Thus in the summary of the review of the findings, it can be stated that the healthy
lifestyle intervention is more effective in managing the high blood glucose (BGL) level
among the patients of T2DM while reducing the other clinical risk factors behind the diabetes
development like the high body weight. The non-pharmacological interventions is associated
with limited side-effects in comparison to the pharmacological (insulin or metformin) for the
effective management of T2DM. Thus in order to generate evidence-based practice
guidelines for the management of T2DM, emphasis must be given to the effective
management of the lifestyle interventions.
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Identification of highest level of evidence
The systematic review and meta-analysis paper conducted by Schellenberg, Dryden,
Vandermeer and Korownyk (2013) falls under the highest level of evidence that skilfully
helps in addressing the PICO questions mentioned in Part A. Moreover, the paper also
coincides with the parameters drafted by the Joanna Briggs Institute (JBI) for measuring the
hierarchy of evidence. This article is considered as the highest level evidence as it helps in
answering a well-defined research question by accumulating and summarising all the valid
empirical research evidences that coincides with the eligibility criteria (Creswell & Creswell,
2017). Furthermore the application of the statistical methods in doing meta-analysis helped in
doing comparison of the research findings of the individual studies that were selected for the
review and thereby helping to increase the reliability of the research. The paper also clearly
identifies the research objectives, reproducible research methodology and has a detailed
history of conduction of the search strategy. This helped in eliminating the level of bias and
at the same time helps to increase the reliability and validity of the information.
Critical appraisal tool
JBI checklist was used for the critical review of methodology of the selected article.
JBI is a global, membership based investigation that helps in analysis of the methodological
significance of the paper and the parameters selected by JBI for the critical analysis of the
paper is approved by the JBI Scientific Committee.
Critical appraisal
Answer 1
Yes. The review question is clearly and explicitly stated in the systematic review
process. Here the main population is adults with type 2 diabetes, interventions include
multifaceted lifestyle interventions, comparison is no significant lifestyle interventions and
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the outcome includes reducing the severity of T2DM among the high risk patients by
reducing the BGL and by reducing the harmful effect of the disease like cardiovascular
disease. The time line include more than three months of follow up. Parahoo (2014) stated
that having a specific research question helps to increase the scope of the research and it also
becomes easier for the readers to understand the process of research.
Answer 2
Yes. The inclusion and the exclusion criteria of the research has been stated in a
definite manner. As the study structure include systematic review and meta-analysis,
appraisers of the meta-analysis was successful in justifying the inclusion criteria for the
statistical analysis. In the selected study five electronic databases were used for the search of
the RCTs that were published within 1980 to 2013. Selection of the wide inclusion criteria for
the review helped to increase the overall validity of the research. The selection of the papers
was done by two separate authors and this helped to avoid the chances of the selection bias.
The review conducted over the high risk T2DM patients were specifically selected for the
study. A detailed PRISMA table was included in order to highlight the process of selection of
the paper. Soares, Hoga, Peduzzi, Sangaleti, Yonekura and Silva (2014) stated that a detailed
elaboration of the inclusion criteria helps to increase the reliability of the research.
Answer 3
Yes. The search strategy selected for the review was appropriate as selection of the
papers were done by two separate reviewers in order to overcome the chances of the selection
bias. The overall approach of search of the articles is elaborated in detail in the appendix
section of the paper.
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Answer 4
No. The final review was conducted by 9 RCTs articles. While RCTs articles were
high in the level of hierarchy of evidences but a total of 9 sample for the review can be
regarded as a drawback of the research. Cleary, Horsfall and Hayter (2014) are of the opinion
that any review that is being conducted below 15 to 20 research appears scoreless in validity
as it limits the generalization of the research results.
Answer 5
Yes. The criteria for appraising the articles were clear and were succinctly elaborated
in the paragraph of the quality assessment. Cochrane Collaboration Risk-of-Bias tool was
used for the analysis of the risk of bias of the selected RCTs. The discrepancies were solved
by consensus or third party adjudicate present in the research. Agency for Healthcare
Research and Quality Evidence based Practice Center approach was further used to examine
the consistency, directness and precision of the selected article. The selection of the article
depending on the risk of bias helps in improving the overall strength of the results (Cleary,
Horsfall & Hayter, 2014). It also helps in replicability of the research results.
Answer 6
Yes. The two authors were used for conducting a critical appraisal of the articles that
were initially selected and this helped to minimize the level of the reviewer bias.
Answer 7
Yes. Efforts were made by the authors during the process of the data collection in
order to reduce the level of bias the systematic errors. The strategies used include use of the
proper instrument in order to guide the process of the data collection or data extraction. The
tool that is being used for the collecting and analysis of the data for the Meta-analyses is
DerSimonian–Laird random-effects model. This is an established model that helps in step-by-
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step data representation (Parahoo, 2014). In case of the systematic review, one reviewer
extracted data with the help of standardized form, and a second reviewer verified data for
determining the accuracy and completeness of the research.
Answer 8
In order to combine the results of the systematic review and the meta-analysis, tabular
representation of the data was done followed by the written interpretation of the data. The
risk ratio in the form of the symbol diagram was used for highlighting the process of the data
interpretation.
Answer 9
No. Egger’s test or funnel plot was not used in order to eradicate the chances of the
publication bias.
Answer 10
No. The study failed to provide any recommendation for policy improvement.
However, it increased the scope for the policy improvement by stating the importance of the
lifestyle interventions.
Answer 11
No. The study failed to provide any recommendation for the future research
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Appendix 1
Search Strategy
# Query Limiters/Expanders Last Run Via Result
s
S6 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
modification or
lifestyle choices )
OR insulin therapy
in type 2 diabetes
AND ( blood glucose
levels or blood sugar
or blood glucose )
AND evidence based
practice in nursing
Limiters - Full Text;
Published Date:
20110101-20191231
Expanders - Apply
equivalent subjects
Search modes -
Boolean/Phrase
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
Complete
147
S5 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
Limiters - Full Text;
Published Date:
20110101-20191231
Expanders - Apply
equivalent subjects
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
148
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modification or
lifestyle choices )
OR insulin therapy
AND ( blood glucose
levels or blood sugar
or blood glucose )
AND evidence based
practice in nursing
Search modes -
Boolean/Phrase
Complete
S4 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
modification or
lifestyle choices )
OR insulin therapy
AND ( blood glucose
levels or blood sugar
or blood glucose )
Limiters - Full Text;
Published Date:
20110101-20191231
Expanders - Apply
equivalent subjects
Narrow by
Language: - English
Search modes -
Boolean/Phrase
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
Complete
154
S3 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
Limiters - Full Text;
Published Date:
20110101-20191231
Expanders - Apply
equivalent subjects
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
158
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modification or
lifestyle choices )
OR insulin therapy
AND ( blood glucose
levels or blood sugar
or blood glucose )
Search modes -
Boolean/Phrase
Complete
S2 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
modification or
lifestyle choices )
OR insulin therapy
AND ( blood glucose
levels or blood sugar
or blood glucose )
Limiters - Full Text
Expanders - Apply
equivalent subjects
Search modes -
Boolean/Phrase
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
Complete
275
S1 ( type 2 diabetes or
type 2 diabetes
mellitus or t2dm )
AND ( lifestyle
changes or lifestyle
modification or
lifestyle choices )
Expanders - Apply
equivalent subjects
Search modes -
Boolean/Phrase
Interface - EBSCOhost
Research Databases
Search Screen -
Advanced Search
Database - CINAHL
Complete
3,121
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OR insulin therapy
AND ( blood glucose
levels or blood sugar
or blood glucose )
Figure: Screen shot of the database search
Source: Created by author
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Figure: Screenshot of the JBI Critical Appraisal Answers
Source: Created by Author
Appendix 2
The final list of articles
Serial No. Name of the Article
1 Chen, L., Pei, J. H., Kuang, J., Chen, H. M., Chen, Z., Li, Z. W., & Yang, H. Z.
(2015). Effect of lifestyle intervention in patients with type 2 diabetes: a meta-
analysis. Metabolism, 64(2), 338-347. doi: 10.1016/j.metabol.2014
2 Schellenberg, E. S., Dryden, D. M., Vandermeer, B., Ha, C., & Korownyk, C.
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(2013). Lifestyle interventions for patients with and at risk for type 2 diabetes:
a systematic review and meta-analysis. Annals of internal medicine, 159(8),
543-551. doi: 10.7326/0003-4819-159-8-201310150-00007.
3 Howells, L., Musaddaq, B., McKay, A. J., & Majeed, A. (2016). Clinical
impact of lifestyle interventions for the prevention of diabetes: an overview of
systematic reviews. BMJ open, 6(12), e013806.
http://dx.doi.org/10.1136/bmjopen-2016-013806
4 Kos, E., Liszek, M., Emanuele, M., Durazo-Arvizu, R., & Camacho, P. (2011).
Effect of metformin therapy on vitamin D and vitamin B12 levels in patients
with type 2 diabetes mellitus. Endocrine Practice, 18(2), 179-184.
https://doi.org/10.4158/EP11009.OR
5 Rosenstock, J., Seman, L. J., Jelaska, A., Hantel, S., Pinnetti, S., Hach, T., &
Woerle, H. J. (2013). Efficacy and safety of empagliflozin, a sodium glucose
cotransporter 2 (SGLT2) inhibitor, as add‐on to metformin in type 2 diabetes
with mild hyperglycaemia. Diabetes, Obesity and Metabolism, 15(12), 1154-
1160. https://doi.org/10.1111/dom.12185
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Appendix 3
PRISMA Chart
18
Articles reviewed from the database search
(n = 147)
Final set of articles title scrutiny (n = 94)
Redundant articles removed (n
=48)
Number of articles removed (n =
54)
Number of articles for Full-text
analysis (n = 11)
Number of articles removed (n =
29)
Articles removed after JBI analysis (n
=4)
Total number of articles for
critical analysis of the
methodology (n =9)
Number of articles not meeting the inclusion
criteria
Conducted over children (n =2)
Final set of articles for the review = 5
The number of articles selected
for the abstract analysis (n = 40)

Running head: NURSING
Appendix 4
SEARCH QUESTION/TOPIC:
Author (s)
(date)
Study
Design
Question
Domain
Key
information
Validity
Check
(eg bias)
Author’s
Results/Findings
Author’s
Conclusions
Reviewer
Comments
(Your
appraisal)
Evidence Source No.
Chen, L., Pei, J.
H., Kuang, J.,
Chen, H. M.,
Chen, Z., Li, Z.
W., & Yang, H.
Z. (2015)
Purpose: The
effect of
lifestyle
interventions
in reducing
BGL of
T2DM
P: Type 2
Diabetes
Patients
(adults)
Poor sample size,
only 16 studies
were selected for
the analysis
Proper observance of
the lifestyle
interventions help in
reducing the risks
factors that increases
the severity of
developing T2DM
Lifestyle
interventions are
effective in reducing
the diabetes severity
Google scholar is used
apart from the
electronic databases
for the research of the
article that reduced
the strength of the
research
I: lifestyle
interventions
C: no lifestyle
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Design:
Meta-
analysis
Level: 1b
Domain:
Experimenta
l Designs
O: Improved
diabetes
management
Evidence Source No.
Schellenberg,
E. S., Dryden,
D. M.,
Vandermeer,
B., Ha, C., &
Korownyk, C.
(2013)
Purpose: The
effect of
lifestyle
interventions
in reducing
BGL of
T2DM and
other clinical
risk factors
of T2DM
P: Type 2
Diabetes
Patients
(adults)
The validity level
is high as two
separate reviewer
was used for the
selection of the
final set of articles
Comprehensive
lifestyle interventions
help to decrease the
blood glucose level
among T2DM
Lifestyle
interventions are
better in comparison
to the medication for
the management of
the T2DM and other
physical
comorbidities
The sample size is
poor with only 9
RCTs were selected
for the review thus
reducing the
generalization of the
study results and
global application for
evidence-based
practice
I: lifestyle
interventions
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C: no lifestyle
interventions
Design:
Systematic
review and
meta-
analysis of
randomized
control trial
Level: 1a
Domain:
Experimenta
l Designs
O: Improved
diabetes
management
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Evidence Source No.
Howells, L.,
Musaddaq, B.,
McKay, A. J.,
& Majeed, A.
(2016)
Purpose: The
effect of
lifestyle
interventions
in reducing
BGL of
T2DM and
preventing
T2DM
P: Type 2
Diabetes
Patients
(adults)
Have moderate of
low risk of bias as
the review was
conducted by
selection of the 19
systematic review
article
Healthy lifestyle
intervention like the
combined diet and
physical activity for
reducing the blood
glucose level among the
patients with T2DM
The authors
conclude that
lifestyle
interventions for the
management of
diabetes have
limited side-effects
unlike medication
management for
regulating BGL in
the long-term
follow-up
Directly coincides
with the scope of this
paper as it help in
understanding the
importance of the
lifestyle interventions
in the long run
I: lifestyle
interventions
C: no lifestyle
interventions
Design:
Systematic
review of
RCTs
Level: 1b
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Domain:
Experimenta
l Designs
O: Improved
diabetes
management
GUIDE
Author (date): include all authors and date of publication
Study design: include purpose, study design , domain, and
level of evidence (LOE) using JBI Key information: include
population/patients (P), intervention (I), comparison (C),
outcomes measured (O)
Validity check: include issues with methodology, rigour, potential
for bias –eg validity, reliability
Results/Findings: include generally favourable or
unfavourable, specific outcomes of interest, estimates of
experimental effect, if appropriate
Author Conclusions: author’s interpretation of findings;
include limitations, implication for practice and research) if
appropriate
Reviewer Comments: include potential for bias, weaknesses and
strengths of study design,
applicability
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SEARCH QUESTION/TOPIC:
Author
(s)
(date)
Study
Design
Question
Domain
Key
information
Validity
Check
(eg bias)
Author’s
Results/Findings
Author’s
Conclusions
Reviewer’
Comments
(Your
appraisal)
Evidence Source No.
Kos, E.,
Liszek, M.,
Emanuele,
M.,
Durazo-
Arvizu, R.,
&
Camacho,
P. (2011)
Purpose:
metformin
risks and
side-effects
P: Type 2
Diabetes
Patients
(adults)
High validity as
the sample size
was high = 706
along with the
confidence
interval of 95%
Patients who are taking
metformin have
significantly low level
of vitamin B12 in
comparison to the
people who are not
receiving metformin for
the management of the
diabetes
Metformin is not
suitable for the
management of GBL
for older adults
Metformin can be used
for management of the
very high BGL for
instant results but long
term use must be
restrictedI: Insulin
C: none
Design:
Cohort
Level: 3d. O: Reducing
BGL and
side-effects of
T2DM
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Domain:
Observationa
l – Analytic
Designs
Evidence Source No.
Rosenstock,
J., Seman,
L. J.,
Jelaska, A.,
Hantel, S.,
Pinnetti, S.,
Hach, T., &
Woerle, H.
J. (2013)
Purpose:
Efficacy of
other
monologues
of the
metformin in
T2DM
management
P: Type 2
Diabetes
Patients
(adults)
High sample size
of 495 people
along with the
study method that
is RCT helped to
increase the
validity of the
study
Empagliflozin when
added along with
metformin is well-
tolerated among T2DM
patients however it
resulted in the genital
infection and also
increase the tendency of
developing
hypoglycaemia
Metforin use is
restricted in the long
term even when
conjugated with other
medication
Genital infection of
men and women
different with age, a
comparative analysis
might have been better
to analyze the results
I: Insulin
C: none
Design: RCT O: Reducing
BGL and
side-effects of
T2DM
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Level: 1c.
Domain:
Experimental
Designs
Evidence Source No.
Purpose: P:
I:
C:
Design:
Level: O
Domain:
GUIDE
Author (date): include all authors and date of publication
Study design: include purpose, study design , domain, and
level of evidence (LOE) using JBI Key information:
include population/patients (P), intervention (I),
comparison (C), outcomes measured (O)
Validity check: include issues with methodology, rigour,
potential for bias
Results/Findings: include generally favourable or
unfavourable, specific outcomes of interest, estimates of
experimental effect, if appropriate
Author Conclusions: author’s interpretation of findings; include
limitations, implication for practice and research) if appropriate
Reviewer Comments: include potential for bias, weaknesses and
strengths of study design
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Running head: NURSING
References
Australian Government Department of Health. (2016). Diabetes. Access date: 16th September
2019. Retrieved from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-diabetes
Australian Institute of Health and Welfare [AIHW] (2019). Diabetes. Access date: 16th
September 2019. Retrieved from: https://www.aihw.gov.au/reports/diabetes/diabetes-
snapshot/contents/how-many-australians-have-diabetes
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