Benchmark – Research Critiques and PICOT Statement Final Draft
The main topic of interest is the management of type 2 diabetes. Type 2 diabetes mellitus (T2DM) is one of the diseases that affect a significant proportion of people globally. My interest in researching the management of T2DM is to determine the best interventions that can reduce diabetes complications among vulnerable patients. The topic is also of great interest since it attempts to identify the best treatments that can be employed to prevent T2DM among vulnerable populations. The research in this topic is also essential in determining the critical processes in the management of complications related to T2DM. This paper will summarize the content from the four study articles, including the background, method of study, results of the study, and ethical considerations in the articles.
PICO Question and Relevance to the Topic
PICO Question: In adult patients with type 2 diabetes mellitus, does the use of lifestyle and behavioral interventions with medications result in better treatment outcomes compared to the use of medications alone in a period of six months?
The PICO question is related to the topic of the management of T2DM since it aims at establishing whether diabetes management with lifestyle and behavioral interventions in addition to medication can result in better health outcomes.
The study by Følling et al. (2016) aimed to identify the best interventions in managing T2DM for patients, both in the communities
and within the healthcare settings. The study was informed by the increasing mortality rates attributed to T2DM. It was also informed by the high cost of treatment of T2DM, increased patient’s suffering, and the rising number of diabetic conditions (Følling et al., 2016). The purpose of the study by Rygg et al. (2017) was to explore participants’ experiences in diabetes self-management education concerning physical activity and diet. The main clinical problem informing the study was the increasing cases of T2DM and the lack of the best intervention strategies for managing the rising population of diabetic patients.
The study by Kempf et al. (2017) explored the efficacy of utilizing a telemedical lifestyle intervention program on advanced stages of T2DM. The study was informed by the increasing rates of patients affected by T2DM. The purpose of the study was to evaluate the efficacy of the telemedical lifestyle intervention program in advanced stages of T2DM (Kempf et al., 2017).The article by Moncrieft et al. (2016) aimed at determining the effect of multicomponent lifestyle intervention on outcome measures such as weight, depressive symptoms, and glycemic control in patients with T2DM. The study was informed by the high mortality rates due to diabetes in patients affected by the disease.
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The four articles share similarities in their comparison and the intervention groups, which will serve as a source of counterfactual causal inference. The studies are significant to nursing since they provide evidence-based information on the effectiveness of lifestyle interventions with medications on the management of diabetes. The articles relate to my PICO since they will help determine the best interventions that can be employed in the management of patients with T2DM to reduce diabetes-related complications among vulnerable patients. They will assist in answering my PICOT question by determining the efficacy of lifestyle and behavioral modifications with medications on the management of diabetes type 2.
Method of Study
The study by Følling et al. (2016) employed a nested qualitative approach with individual semi-structured in-depth interviews. The researchers found appropriate and adequate for the study as the sample reflected the characteristics of the entire population under the study. The advantage of the case study method is that it allows a lot of details to be gathered, a scenario that cannot be easily achieved by other research designs. The disadvantage is that some case studies may not be scientific, and the data collected cannot be necessarily generalized to the wider population (Liang, 2019). The study article by Rygg et al., (2017) was phenomenological since it focused on the commonality of life experience within the diabetic patients in the study. The researcher felt that the sample was adequate and represented the true characteristics of the entire population. The advantage of the phenomenological method is that it helps adjust to new issues and ideas as they emerge (Liang, 2019). The disadvantage is that there are always challenges with the analysis and interpretation of the result.
The study by Kempf et al. (2017) employed a randomized, controlled, interventional study. The outcome measures comprised changes in HbA1c in groups, body weight composition, cardiovascular disease risk factors, and eating behaviors between the participants in the treatment and control groups. The study by Moncrieft et al. (2016) also employed a randomized controlled trial. The study participants in the treatment group received usual care in addition to multicomponent behavioral interventions on glycemic control, weight, renal function, and depressive symptoms. Quantitative research is valuable when examining the management of T2DM since the benefits and limitations of the quantitative methods can be generalized (Liang, 2019). The randomized controlled trials are valuable to my topic of interest since the data has high reliability attributed to the randomization of the participants into the treatment and control groups.
Results of Study
The qualitative study by Følling et al. (2016) found that the lifestyle and behavioral program was acceptable for implementation in the prevention of T2DM. Nonetheless, the lifestyle and behavioral program should be designed to meet the cultural needs of different participants (Følling et al., 2016). The participants reported that lifestyle and behavioral interventions increased their awareness of preventive measures for T2DM. The study by Rygg et al., (2017) revealed that after the Diabetes self-management education, the participants were more optimistic about diet since they had learned how to interpret food labels and compose their meals (Rygg et al., 2017). They also perceived the benefit of physical activity in relation to their blood glucose levels.
The results in the two articles are similar in that they revealed that lifestyle modification on diet and physical activity in the prevention and management of T2DM. However, Article 1 revealed the need to design lifestyle interventions based on an individual’s cultural needs, which was not the case in Article 2. The study results would help make a change in nursing practice by introducing newly diagnosed T2DM patients on a lifestyle modification program designed to meet their cultural needs to help manage the condition and prevent T2DM related complications.
The study by Kempf et al. (2017) found that the use of a telemedical lifestyle intervention program was associated with a significant reduction in HbA1c in the treatment group. Besides, the implementation of the telemedical lifestyle intervention program led to significant improvements in secondary outcomes. The study by Moncrieft et al. (2016) showed that the application of multicomponent interventions resulted in significant improvements in the management of T2DM. Furthermore, there was a substantial decrease in the weight of the participants in the treatment group compared to participants in the control group. The multicomponent intervention was also associated with a reduction in depression symptoms and glycosylated hemoglobin and improvement in glomerular filtration rate in the treatment group than the control group.
The articles reveal that the implementation of lifestyle and behavioral interventions together with medications is associated with better treatment outcomes in patients T2DM. The information from the articles’ result findings relates to nursing practice as they provide immense knowledge on nursing practices that can be implemented in the management of patients with T2DM to prevent complications and promote better health outcomes. Therefore, it is crucial for nurses and other health providers to implement the use of lifestyle and behavioral interventions in the management of diabetic patients. The articles’ findings provide essential information that can be applied in my project to determine the best interventions that can be employed to reduce diabetes complications among vulnerable patients. The findings can also determine the best treatment that can be used to prevent T2DM among vulnerable populations.
Research ethics are a set of ethics that direct how scientific and other research are performed at research institutions and how it is disseminated. They are based on three fundamental principles: Respect for persons, which state that participants should be treated as autonomous, and those with diminished autonomy should be protected. Beneficence requires the researcher to do no harm, maximize benefits for participants, and minimize risks (Woodfield & Iphofen, 2017). Justice requires that researchers designing trials consider what is fair in terms of recruitment of participants and choice of location to conduct a trial. Research ethics are vital since they promote the aims of the research and support the values required for collaborative work such as mutual respect and fairness (Woodfield & Iphofen, 2017). Furthermore, they signify that researchers can be held accountable for their actions and ensure that the public can trust research (Woodfield & Iphofen, 2017). Research ethics also support essential social and moral values, such as the principle of nonmaleficence.
The researchers on the four articles employed ethical practices such as confidentiality of information and respect for human dignity. They were able to protect participant’s data and information obtained and managed to conduct the studies in line with the standards that protect human dignity, especially for the study participants (Woodfield & Iphofen, 2017). The researchers adhered to the confidentiality standards and respect for human dignity and upheld the protection of privacy in the study.
Anticipated outcome from the PICOT question is that the implementation of lifestyle interventions and behavioral modifications with medications will result in better treatment outcomes in patients with T2DM compared to the usual care of medications use alone. The articles by Kempf et al. and Moncrieft et al. reveal improvement in outcomes in measures such as level of HbA1c, weight, symptoms, glucose monitoring, and hospital visits and admission due to diabetic-related complications from lifestyle and behavioral modifications. Furthermore, the studies by Følling et al. (2016) and Rygg et al. (2017) reveal the effectiveness of lifestyle intervention programs in the prevention and management of T2DM. The study articles demonstrate the enhanced effectiveness of the proposed lifestyle and behavioral interventions, hence, their relevance to the PICOT statement. In addition, they support the PICOT question by establishing the benefits of lifestyle interventions in the prevention and management of T2DM.
Følling, I. S., Solbjør, M., Midthjell, K., Kulseng, B., & Helvik, A. S. (2016). Exploring lifestyle and risk in preventing type 2 diabetes-a nested qualitative study of older participants in a lifestyle intervention program (VEND-RISK). BMC public health, 16(1), 876.https://doi.org/10.1186/s12889-016-3559-y
Kempf, K., Altpeter, B., Berger, J., Reuß, O., Fuchs, M., Schneider, M., Gärtner, B., Niedermeier, K., & Martin, S. (2017). Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care, 40(7), 863-871. https://doi.org/10.2337/dc17-0303
Liang, J. (2019). Qualitative research methods: Collecting evidence, crafting analysis, communicating impact: by SJ Tracy, West Sussex, UK, John Wiley & Sons, Ltd. 368 pp., $115.50 (hardback), ISBN: 978-1-4051-9202-3.
Moncrieft, A. E., Llabre, M. M., McCalla, J. R., Gutt, M., Mendez, A. J., Gellman, M. D., Goldberg, R. B., & Schneiderman, N. (2016). Effects of a Multicomponent Lifestyle Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients with Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial. Psychosomatic medicine, 78(7), 851–860. https://doi.org/10.1097/PSY.0000000000000348
Rygg, L. Ø., Løhre, A., & Hellzèn, P. O. (2017). Lifestyle Changes in Diet and Physical Activities after Group Education for Type 2 Diabetes–The Active Ingredient in the Education. A Qualitative Study. https://doi.org/10.4236/ojn.2017.710086
Woodfield, K., & Iphofen, R. (2017). Introduction to Volume 2: The Ethics of Online Research. Bingley: Emerald Publishing Limited, 1-12.