University Nursing Assignment: Diabetes Self-Management Review

This nursing assignment report critically appraises the evidence supporting self-management interventions for patients with diabetes. The report begins by highlighting the increasing global prevalence of diabetes and the importance of effective management strategies. A PICOT question is formulated to guide the literature search, focusing on the effectiveness of self-management interventions compared to pharmacological interventions in improving patient outcomes within six months. The report then details the search strategy using PubMed, including keywords and Boolean operators, and outlines the inclusion criteria for selecting relevant studies. Three systematic review articles are evaluated, with each study's purpose, design, population, intervention, outcome measures, findings, limitations, and level of evidence (Level I or II) carefully analyzed. The first study, a systematic review and meta-analysis, investigates the effectiveness of self-management interventions in type 1 and type 2 diabetes. The second article, also a systematic review, focuses on identifying effective self-management interventions for diabetes patients. The third study, a systematic review of randomized control trials, is also analyzed. The report concludes by synthesizing the findings, emphasizing the effectiveness of self-management interventions in improving outcomes for patients with diabetes.

Running head: NURSING ASSIGNMENT
CRITICAL APPRAISAL WRITTEN REPORT
Name of the student
Name of the university
Author note

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As per the World Health Organisation, diabetes is one of the critical healthcare
complications due to which the global morbidity and mortality rate is increasing [1]. As per
the statistical data provided by this organisation, the number of patients suffering from
diabetes has increased more than thrice since 1980 [1]. As per the latest study, 422 million
people around the globe is suffering from diabetes and the prevalence of disease has doubled
from 4.7% in 1980 to 8.5% in 2014. Moreover, if the morbidity and mortality rates are
considered, more than 1.6 million people were registered dead due to their improper diabetes
management [4]. Further as per researchers improper management of diet, physical inactivity,
improper weight management and addiction to different substances increases the morbidity
and mortality associated with this disease [2[. Hence, application of self-management could
be an effective means to increase the diabetes management rate among patients suffering
from chronic condition.
The PICOT question selected for collecting evidences from recent literatures was as
follows:
Population Intervention Control Outcome Time
Patients
affected with
chronic
diabetes.
Self-
management
Pharmacologica
l interventions
Improves
patient
condition
Within 6
months
PICOT question: do the application of self-management interventions compared
to the pharmacological interventions helps to improve the patient condition within 6
months?

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To find evidences based on this PICOT question, the database PubMed was searches
with several effective keywords, connected with Boolean Operators such as AND, OR and
NOT. The keywords are as follows: “self-management AND Diabetes AND effectiveness”,
self-management AND Diabetes OR effectiveness”, “self-management AND Diabetes NOT
effectiveness”, “self-management AND/OR pharmacological intervention AND diabetes
AND effectiveness AND systematic review”, “self-management AND/OR pharmacological
intervention AND diabetes AND effectiveness AND systematic review OR/NOT randomized
control trail” “1 AND/OR 2”, “1 AND/OR 3”, “1 AND/OR 4”. The search was refrained with
several inclusion criteria including research papers from 2013 to 2019 so that effective results
could be obtained. 3 systematic review paper were found and the following section would
discuss their level of evidence.
The first article included papers from randomized control studies and hence, as per the
level of evidence, the study was of Level I. Further, in this paper, studies of randomized
control trail was collected from eight renowned databases including the Cochrane library and
in the process, the researchers conducted the quality of the papers through the application of
R AMSTAR critical appraisal tool. Hence, this paper was selected for the assessment [4].
The second article was included as it conducted a systematic review by including 14
research articles through meta-analysis and in this process identified 12 interventions
associated with self-management so that patients with diabetes could be provided with
effective healthcare interventions. Further, the papers with randomised controlled trials
(RCTs), non-randomised controlled trials, and quasi experimental studies were included in
the paper, hence the level of evidence was level I [5].
The third article selected for this process included a research in which the researchers
included 32 randomized control trail to understand the self-management activities in

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maintaining patient condition. However, it was seen that the paper lacked proper
recommendations and the competing interests in this aspect due to which the level of
evidence of this paper decreased, it could be categorised in the level II of the evidence [6].
Hence, al the evidences indicated towards the effectiveness of self-management
related intervention for the effective treatment of the diabetes among [patients, and in this
process level I and level II articles with systematic review of randomized control trails were
selected for the detailed analysis.

Running head: NURSING ASSIGNMENT
First
author,
year, title
Study purpose Study design (inc
inclusion exclusion
criteria)
Study population
& setting
Intervention
description
Outcome
measures
Findings Limitations
Evidence
Level
Systematic reviews/ meta-analyses : Evidence Level I
Captieux,
M. et al.
2018,
Supported
self-
managemen
t for people
with type 2
diabetes: a
meta-
review of
The aim of the
study is to
understand the
effectiveness of
self-management
among people
with diabetes type
2 and comparing
the intervention
to identify the
best evidence for
Systematic review
was conducted with
MEDLINE,
EMBASE,
CINAHL,
PsychINFO,
AMED, BNI,
Cochrane Database
of Systematic
Reviews and
Database of
In this systematic
review 41 studies
with RCT as the
primary research
process were
selected from more
than 40 countries so
that focuses on the
interventions and
self-management
among patients
Different self-
management
strategies were
implemented in
the patient’s so
that their
improper
management of
diabetes
condition and
its adverse
Primary
outcome:
patients with
type 1 and type
2 diabetes were
able to
overcome their
diabetes
condition
effectively with
application of
Diverse self-
management
strategies were
found to be
effective against
the type 1 and
type 2 diabetes
and increased
the ability of the
patients to
overcome their
The paper did
not include
fine-grain
details of the
meta analysis
studies
included in the
study due to
which the
effectiveness
of the paper

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quantitative
systematic
reviews.
the patients Abstracts for
Reviews of
Effectiveness
(DARE). And
papers with 1993 to
2012 were selected
for the assessment.
In this aspect, the
RCTs were selected
for the assessment.
Inclusion criteria:
papers within the
selected timeframe,
in English
language, within
the RCT study and
with type 2
diabetes. In this
process all the
short-term, medium
term and long term
interventions were
included so that
interventions and
their effectiveness
could be
understood.
events could be
lowered with
effective and
accurate self-
management
skills. Further,
the 97% of the
cases were
inclusive of
interventions
developed by
the patients so
that patients and
their ability to
implement self-
management
interventions
associated with
self-
management
technologies.
health condition. affected.
However, it
was a level 1
evidence
study.

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with diabetes
management were
selected for the
analysis.
The exclusion
criteria included:
language other than
English, subjects
with disorder other
than diabetes,
interventions other
than self-
management and
papers with
improper data
strategies could
be identified.

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analysis process.
Fredrix, M.
2018,
Goal-
setting in
diabetes
self-
managemen
t: A
systematic
review and
meta-
analysis
examining
content and
effectivenes
The aim of this
paper is to
understand the
effectiveness of
goal setting and
diabetes self-
management
among patients
suffering from
chronic diabetic
condition.
Systematic review
was conducted in
several healthcare
databases and the
guideline which
was used for this
assessment was
International
Prospective
Register of
Systematic
Reviews.
Inclusion criteria:
the papers that were
included in the
The study
population included
patients with blood
glucose associated
self-management
and in this process
their behavioural
change techniques
were determined.
The
intervention
was associated
to weight
management
and controlling
the blood
glucose level so
that patients
could be
provided with
effective
techniques to
improve their
diabetes
Primary
outcome:
associated with
patient’s
controlled
weight and
blood glucose
after the
implementation
of intervention.
Secondary
outcome:
physical,
psycho-social
and behavioural
Significant
improvement
among patients
with diabetes
was observed
after weight
management
and blood
glucose
management
associated
effective
treatment and
hence, this was
determined as
The BCT
analysis was
not conducted
effectively and
hence, coding
difficulty was
observed in
this case.
Further, the
fidelity of the
paper was not
discussed.
The level of
evidence was
type I level of

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s of goal-
setting
intervention
s.
study was English
language, effective
intervention related
to self-management
among the patients
with diabetes,
within the specific
time frame.
Exclusion criteria:
language other than
English, improper
data collection and
analysis,
intervention other
than self-
management and
management modification
were observed
in this
systematic
analysis
the effective
intervention for
diabetes
management.
evidence.

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disease other than
diabetes.
Systematic review : Evidence level II
Coyle, M.
E., 2013,
Self-
managemen
t activities
in diabetes
care: A
systematic
review
The primary
objective of this
paper is to
identify the wide
range of
interventions
associated with
self-management
so that its
effective ness in
diabetes, its
accurate
frequency and its
The researchers
conducted a
systematic review
with the range of
databases such as
PubMed, Embase,
CINAHL, andthe
Cochrane Library
and the range of
timeline was
inception to 2012.
The inclusion
32 papers with
RCTs were
included in the
paper, 513 patients
with diabetes were
assessed.
In this twenty two
paper included in
the paper as self-
monitoring blood
glucose. , whereas
25 papers discussed
This paper
discussed
several
interventions
for the
discussion and
monitoring of
blood glucose
level, diet
management
and
management of
physical
Primary
outcome: the
patients were
able to
overcome their
diabetes
condition.
Secondary
outcome:
patients were
able to
overcome their
This systematic
review found
that diet,
physical
activity, foot
care and other
associated
healthcare
condition is
effective in
diabetes self-
management
condition.
The paper was
unable to
provide the
details of the
physical
activity or the
type of diet or
the degree of
the
interventions
which is
required for
the healthcare

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utilization among
patients could be
understood.
criteria included:
paper with self-
management skills,
in English
language, proper
rate and frequency
of the self-
management
intervention and the
time utilized in self-
care and the
presence of disease
related to type 1
and type 2 of the
disease. Further
RCTs, with
about diet and self-
management
interventions for
diabetes
management.
Further, 28 studies
were inclusive of
physical activity
associated self-
management for
such process.
inactivity and
foot care were
included in the
study as
intervention for
diabetes
management so
that patients
could be
provided with
effective means
for their
diabetes
treatment.
improper health
and diet as well
as physical
inactivity due to
which the
diabetic
condition was
controlled.
However, the
ability of the
patient in
adhering to the
condition is
deciding in this
condition.
development
of the patients
in diabetes
condition.
As the paper
did not
included a
proper
recommendati
on and lacked
the degree of
interventions
the paper was
of evidence
level II

7NURSING ASSIGNMENT
inpatient and
outpatient programs
were included in
the paper.
Exclusion criteria:
Studies that focuses
on interventions
other than self-
management,
language other than
English, subjects
without type 1 or
type 2 diabetes and
improper study
design with
improper data

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collection method

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References
1. Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology. 2014 Jan
1;2(1):56-64.
2. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and
projections for 2035. Diabetes research and clinical practice. 2014 Feb 1;103(2):137-49.
3. Majumdar A, Sahoo J, Roy G, Kamalanathan S. Improper sharp disposal practices among diabetes patients in home care settings: need
for concern?. Indian journal of endocrinology and metabolism. 2015 May;19(3):420.
4. Captieux M, Pearce G, Parke HL, Epiphaniou E, Wild S, Taylor SJ, Pinnock H. Supported self-management for people with type 2
diabetes: a meta-review of quantitative systematic reviews. BMJ open. 2018 Dec 1;8(12):e024262.
5. Fredrix M, McSharry J, Flannery C, Dinneen S, Byrne M. Goal-setting in diabetes self-management: A systematic review and meta-
analysis examining content and effectiveness of goal-setting interventions. Psychology & health. 2018 Aug 3;33(8):955-77.
6. Coyle ME, Francis K, Chapman Y. Self-management activities in diabetes care: a systematic review. Australian Health Review. 2013
Oct 1;37(4):513-22.