Evaluating Glucose Monitoring Strategies for Type 1 Diabetes Patients

This report investigates the role of glucose monitoring in managing type 1 diabetes in adults, focusing on achieving target HbA1c levels while minimizing the risks of weight gain and hypoglycemia. The research question, developed using the PICO approach, examines the effectiveness of continuous glucose monitoring (CGM) and self-monitoring blood glucose (SMBG) compared to standard care. The report evaluates the research design, which combines meta-analysis and review methods, emphasizing patient confidentiality and consent. It explores the challenges of cost and accessibility of advanced technologies like CGM, particularly for patients at higher risk of complications. The literature review analyzes three articles, highlighting the benefits of glucose monitoring, the impact of CGM on glycemic excursions, and the importance of individualized nursing interventions. The report also provides recommendations for future research, suggesting constructive research methods and meta-analysis to further investigate cost-effective strategies and patient awareness. It emphasizes the need for quantitative research to assess the accessibility and impact of CGM and SMBG on patient outcomes. References include journal articles and online resources related to diabetes management and chronic conditions.

Evidenced Based Nursing
Practice

TABLE OF CONTENTS
RESEARCH QUESTION................................................................................................................1
Criteria for selection of research recommendations....................................................................1
Research Evaluation.........................................................................................................................1
Research Topic.................................................................................................................................2
Literature Review.............................................................................................................................2
Article 1.......................................................................................................................................2
Article 2.......................................................................................................................................3
Article 3.......................................................................................................................................4
Recommendations for future research.............................................................................................4
REFERENCES................................................................................................................................6

RESEARCH QUESTION
How regular glucose monitoring can help adults with type 1 diabetes to achieve their
targets of recommended HbA1c without encouraging the risk of weight gain and
hypoglycaemia?
Criteria for selection of research recommendations
Research question has been chosen on the basis of following criteria of PICO approach.
Population: Adult patients with diabetes of type 1
Intervention: Methods and techniques which monitors glucose and achieves the desired HbA1c
level
Comparison: Present technologies like SMBG and CGM along with usual care methods of
monitoring glucose and insulin dose management.
Outcomes: Change in HbA1c level, weight change, cost effective methods, diabetes specific
quality measurements and analysis related to hypoglycaemia.
I have developed the research question by analysing articles related to impact of blood
glucose management in controlling severity of diabetes in adults. The weight gain and HbA1c
are major factors in creating awareness among adults regarding current strategies of diabetes
management (Atkinson, Eisenbarth & Michels, 2014). The various statistics from Australian
Institute of Health and welfare also helped me to develop base for the research question.
Research Evaluation
The article (Type 1 Diabetes in Adults: Diagnosis and Management, 2015) is chosen as
the primary article and research design used in the report is the combination of meta-analysis
design method and review based design method. It uses a systematic review to analyse the
controlled trial of CGM and for achieving glycaemic goals in case of type 1 diabetes. It also
emphasises on focusing the need to consider the adverse effects of the event. In this way, it can
provide productive outcomes for the patients with severe hypoglycaemia. The Meta analysis of
target group reveals that sufferers of diabetes must have knowledge regarding their blood
glucose level (Hussain, 2016).
The research principles which provide confidentiality and consent are strictly followed.
The participants such as adults with obesity and high glucose level can withdraw from research.
The research does not cause harm to individuals and assure their consent prior to survey. The
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health care providers believe that development of CGM devices which are cost effective as well
as consider risk factors are effective to minimize severity of type 1 diabetes. Continuous glucose
monitoring system (CGM) is effective but not economically feasible. Thus, they need to be
complemented with advancements and innovations so that its cost can be reduced and it can give
more productive results with patients of higher HBA1c.
Research Topic
The research topic analyses role of continuous glucose monitoring strategy in adults who
are at higher risk of side effects such as obesity. Most of the adults are not able to access these
technologies due to cost factor. The present techniques such as self-monitoring blood glucose
(SMBG) are easily accessible but particularly they are unable to manage factors like obesity.
Thus, certain more advanced methods like CGM can be applied but still there is need of
researches so that it can be made cost effective (Aleppo & et.al., 2017). The chronic-diseases can
be controlled by providing continuous care and awareness.
The patient partnership can be a great milestone in achieving these goals. The research
will demonstrate that how CGM tools will make it easy for adults to interact with their health
care providers for resolution of queries related to these methods. The cost factors restrict many
patients from using the availability tools (National Strategic Framework for Chronic Conditions,
2017). There are certain sections of the society which have not experienced much development.
Thus lack of knowledge, awareness prohibits them from using these approaches. In such regions,
the technologies are not even accessible and thus, government schemes and awareness programs
through such researches can help authorities to improve health conditions of these patients.
Literature Review
Article 1
Article Type 1 Diabetes in Adults: Diagnosis and Management, 2015 provides research
guidelines for interventions and improved technologies like cell based therapies, continuous
glucose monitoring and insulin replacement in patients of type 1 diabetes. It has evaluated that 1
patient with type 1 diabetes must engage in these activities. Currently the patients faces the
difficulties to obtain the desirable outcomes due to unpredictability in estimating requirements of
insulin. The side effects of diabetes such as weight gain, hypoglycaemia serves as the barriers to
achieve these tasks. The research has been carried out by comparing the outcomes of patients
with specialist’s health care support to those who seek treatment from non-specialist with
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standard set of skills. It has analysed the strategies which can reduce the risks associated with
insulin therapies so that more advanced and cost effective treatments can be identified.
Thus, this area will help patients to regulate their sugar level at low cost methods.
Currently many sections of the society are unable to treat chronic complications due to expensive
costs. The innovations and implementations in the above researched area will be helpful for the
working adults that they can match the efficiency level of their peers which are not affected by
chronic diseases (Engler, Routh & Lucisano, 2017). These methods will help nurses and health
service providers to improve psychological as well as physical health status of the adults. The
current techniques of intensified insulin therapy is also not able to completely achieve the desired
levels of blood glucose.
Article 2
According to Type 1 Diabetes and Glucose Monitoring, 2007 complexity of diabetes is
influenced by variable nature of glucose. Mean amplitude of glycaemic excursions (MAGEs) is
based upon CGM and is used to assess the role of postprandial glucose in body sugar
fluctuations. The devices such as CGM can give accurate data of 7 days which can be analysed
by the nurses to evaluate both higher and lower levels of glucose alarm. However, with these
approaches the hypoglycaemia level is recognised with delay. The CGM will help diabetic
patients to modify their lifestyles. For example physical inactivity for long duration can lead to
the development of these diseases (Chronic disease, 2018).
Thus, for adults with these issues must move towards a healthier life style such as regular
workout and limited consumption of smoking and alcohols. Nurses must give education to their
patients regarding pattern in which glucose level may fluctuate. The patients can use insulin
boluses to eliminate and minimise the risk of hypoglycaemia. Thus, it is observed that for all
sufferers of hypoglycaemia the glucose monitoring equipment are effective. In order to reduce
the variability and to give more detailed analysis of glucose data points with more accuracy
CGM can gives better results than hyperglycaemia. However, it is essential to consider that
adults who does not required improvement in A1c and are less vulnerable to hyperglycaemia and
weight gain the capillary monitoring tools can be sufficient.
Article 3
In the view of Type 1 Diabetes in Children and Adolescents, 2013 glycemic goals can be
achieved aggressively by controlling metabolism in adults with type 1 diabetes. Severe
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hypoglycaemia can be a result of poor cognitive function. Nurses can make attempts to improve
the metabolic control among adults and children by setting appropriate nursing goals and
interventions. The family centred care approach can be every effective for achieving these targets
(National Strategic Framework for Chronic Conditions, 2017). For choosing the insulin regimen
nurses must consider factors like age, duration of the diseases, social and economic factors and
their preferences. Hyperglycaemia acts as the major obstacle for these sufferers thus nurses can
treat them by providing intravenous dextrose.
When these patients will use the glucose monitoring methods in their routine practices
then, it will surely help them to improve glycaemic status. This will help in reducing the
complications such as weight gain and diabetic ketoacidosis. The Meta analysis of currently used
insulin pump method indicates that they give minor improvements in controlling. Instead,
glucose monitoring can provide benefits if used continuously. The research in the area will also
identify the literacy, financial and social barriers which restricts the structured knowledge to
convert into practices. It does not include technical issues and is considered as feasible so that
most of the diabetic adults will be able to use it and will lead to a healthier lifestyle.
Recommendations for future research
For improving the health status of the patients with diabetes the future researches can be
conducted by constructive research methods and meta-analysis approach. The presented report
uses a systematic analysis. In this methodology procedures and data are analysed so that they can
give relevant evidences to question to be researched. In future the analysis by constructive means
will help health providers to define problems on the basis of theories (Hussain, 2016). For
example the CGM is integral part of the diabetes management but the research can describe that
how this approach can be cost effective and can help to create awareness.
The research will also suggest and identify the ways through which these techniques can
avoid risks such as obesity and hypoglycaemia. The quantitative research methodology can be
used to collect facts and information regarding information like how many people have access
and awareness about CGM, and what percentage of group with obesity can easily meet there
glucose levels and what factors restricts them to achieve their goals (Atkinson, Eisenbarth and
Michels, 2014). The Meta analysis observations will evaluate the impact of these methods on
targeted audience through surveys and medical records.
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REFERENCES
Books and Journals
Aleppo, G., Ruedy, K.J., & et.al., (2017). REPLACE-BG: A randomized trial comparing
continuous glucose monitoring with and without routine blood glucose monitoring in
well-controlled adults with type 1 diabetes. Diabetes Care, p.dc162482.
Atkinson, M.A., Eisenbarth, G.S. & Michels, A.W., (2014). Type 1 diabetes. The
Lancet.383(9911). pp.69-82.
Engler, R., Routh, T.L. & Lucisano, J.Y., 2017. Adoption barriers for continuous glucose
monitoring and their potential reduction with a fully implanted system: results from
patient preference surveys. Clinical Diabetes, p.cd170053.
Hussain, S., (2016), April. Threshold analysis of design metrics to detect design flaws: student
research abstract. InProceedings of the 31st Annual ACM Symposium on Applied
Computing (pp. 1584-1585). ACM.
Online
Chronic disease, 2018 [Online] Accessed through
<https://www.aihw.gov.au/reports-statistics/health-conditions-disability-deaths/chronic-
disease/overview >
National Strategic Framework for Chronic Conditions, 2017 [Online] Accessed through
<https://www.health.gov.au/internet/main/publishing.nsf/Content/A0F1B6D61796CF3D
CA257E4D001AD4C4/$File/National%20Strategic%20Framework%20for%20Chronic
%20Conditions.pdf >
Type 1 Diabetes and Glucose Monitoring, 2007 [Online] Accessed through
<http://care.diabetesjournals.org/content/30/11/2965>
Type 1 Diabetes in Adults: Diagnosis and Management, 2015 [Online] Accessed through
<https://www.ncbi.nlm.nih.gov/books/NBK343364/>
Type 1 Diabetes in Children and Adolescents, 2013 [Online] Accessed through
<https://www.canadianjournalofdiabetes.com/article/S1499-2671(13)00043-9/fulltext>
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