Abstract
Diabetes is a chronic disease that mainly affects the older population. This paper discusses useful interventions that have been shown to yield better results. In all these studies, there is an emphasis on specialized care for diabetic patients. This kind of care is associated with better health outcomes about glycemic indices compared to routine and generalized care.
Diabetes is a global health issue that affects thousands of people in every nation. The disease is more prevalent in some communities and tribes in comparison to others, but the actual reason for this variation is not explicitly understood. However, experts attribute this to genes and environmental factors. There has been an exponential increase in the occurrence of diabetes in the US, and it is estimated that at least a third of Americans born in 2000 will develop diabetes at some point in their lives (Narayan, Boyle, Thompson, Sorensen & Williamson cited in Yoo, Lee, Lee & Kim, 2007).
The situation has not been any different in most other countries such as Korea, which has also seen a sharp increase in the prevalence rate of diabetes; 1% during the 1970s to more than 20% in 2000. Glycemic control through long-term lifestyle changes (healthy diet and regular exercise) has been shown to yield positive results in comparison to mere education programs. Unfortunately, there is usually a lack of commitment to self-management of diabetes, which is crucial for successful results. In the study by Lee, Ahn & Kim (2009) in Korea, management of diabetes yields better results when managed by a specialist in comparison to a generalist.
Nursing research study in Korea
Synopsis
The article “The Effect of a Comprehensive Lifestyle Modification Program on Glycemic Control and Body Composition in Patients with Type 2 Diabetes” by Yoo, Lee, Lee & Kim (2007, p. 106-115) aims at investigating the long-term effects of the comprehensive lifestyle modification program (CLMP) on glycemic control and body composition among type 2 diabetic patients. The CLMP is an intervention aimed at promoting self-management of diabetes.
The sample for this study was randomly recruited from the study area: a university medical center in Korea. The study included adults at least 35 years who had diabetes type2 and on medication that had not been altered for at least 3 months before the study. Also, the participants were not on insulin and did not have a history of psychiatric and eating disorders, Also, they were able to engage in physical activity.
Patients were excluded from the study if they changed their drug regimen or failed to adhere to the program. Initially, 60 patients had been recruited but after faults in eligibility criteria, only 48 patients participated in the ultimate study. Clinical indicators were used to determine the outcomes of the program. Hospital records were used to obtain demographic and body composition information. Glycemic indices significantly improved for the experimental group in comparison to the control group, but there was no significant difference between the two groups concerning body composition.
Credibility
An experimental design was employed, and randomization was used to minimize bias. Also, the inclusion and exclusion criteria were used to control extraneous variables. Validity was determined using statistical power to ensure that the sample selected was sufficient for generalization of results in an area of similar characteristics as the study area. Reliability was predetermined using the power table. The study results are consistent with previous studies in as far as improvements in glycosylated hemoglobin (HbA1c) and fasting blood sugar are concerned. However, variation with other studies has been seen for body composition, and this has been attributed to the fact that the experimental group tended to overeat.
Summary
The paper showed a high rate of adherence to the CMLP. The CMLP was associated with better glycemic indices control. Although body composition in the experimental group was not significantly different from body composition in the control group, the quality of diet in the two groups was significantly different as indicated by the glycemic indices.
Nursing Research in Korea
Synopsis
The article “Self-care, Self-efficacy, and Glycemic Control of Koreans with Diabetes Mellitus” by Lee, Ahn & Kim (2009, p. 139-146) aims at comparing the outcomes of diabetes management from two different types of health caregivers: the specialist and the generalist. Questionnaires were used to obtain data on lifestyle habits and body composition. Participants included in the study had type 2 diabetes, were not physically disabled and their cognitive ability was sound. 174 patients fulfilled the inclusion eligibility criteria, and they were all included in the study.
Credibility
The comparative survey design used was appropriate, but the use of pre-test data was not ideal because a pre-test is filled with faults that often require modification. The reliability for all the research instruments was determined using test-retest correlation. The fact that all participants were included assures attainment of external validity; hence, delimitation of results was guaranteed.
Also, the validity of questions and language used concerning the target population was determined by experts in the field, and essential modifications were made. Extraneous factors such as education and income, which could have an impact on the results, were controlled. Appropriate statistical tests were used about the studied variables. Following previous studies, the study results indicated that the patients attended to by the specialists had better outcomes compared to patients attended to by generalists.
Summary
Self-care practices are still the best approaches in the management of diabetes type 2. There are disparities in the provision of health care between specialists and generalists. Patients seeing specialists adhered to self-management practices more compared to those seen by a generalist.
Nursing Research in Hong Kong
Synopsis
The article “The effectiveness of diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control” by Chan, Yee, Leung & Day (2006, p. 770-781) aims at investigating the effectiveness of a diabetes nurse clinic in the management of diabetes type 2. This nurse clinic was an intervention that adhered to certain outlined protocols. Data was obtained from filling in questionnaires and clinical parameters. The sample size was determined using statistical power and this helped in the attainment of external validity. The intervention was associated with better-controlled glycemic indices.
Credibility
The study is peer-reviewed and the quasi-experimental design used was appropriate for the study. The data obtained answered the research question. The statistical analysis used was relevant to the data collected. Qualitative data were numerically coded to allow for the application of inferential statistics. Randomization was used to reduce bias while selecting patients at each visit. However, assigning participants to either group was not random. Also, explicit inclusion and exclusion criteria further helped to reduce bias. Experts in endocrinology were used for the attainment of content validity. Also, reliability was attained using the test-retest correlation. Just like in previous studies, there was a significant improvement in glycemic indices in the experimental group in comparison to the control group. The results are not 100% credible because the methodology used introduced some bias while assigning participants to either group.
Summary
This study indicated that specific nurse-led interventions have an impact on the glycosylated hemoglobin glycemic index of diabetes type 2 patients. The diabetic nurse clinic was used to indicate that clinics tailored for diabetic purposes only yield better results compared to routine clinics. Although care provision is not significantly different, paramount success indicators such as the HbA1c are evident in specialized diabetic care,
Nursing Research in the US
Synopsis
The article “Integrating Nurse-Directed Diabetes Management into a Primary Care Setting” by Davidson, Blanco-Castellanos & Duran (2010, p. 652-656) aims at comparing two models in the management of diabetes type 2. There is neither mention of how the participants were included in the study nor the eligibility criteria used when recruiting the participants. The intervention given is incomprehensible. Although patient education took place, the reader does not understand the contents of this education.
Credibility
This study has given minuscule details about the methodology used to carry out the study. Clinical variables were obtained to determine the outcome measures based on the American Diabetes Association (ADA) goals. Details of determining the reliability and validity of research instruments are missing; hence, the reader is not assured about the credibility of the results. Also, the participants taking part in this study had varied characteristics.
Summary
This study aims at comparing two models in the provision of care for the management of diabetes type 2. Unfortunately, the reader is not sure of the credibility of the methodology used. As a result, the results are not valid and reliable.
References
Chan, M., Yee, A., Leung, E., & Day, M. (2006). The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control. Journal of Clinical Nursing, 15, 770-781.
Davidson, M., Blanco-Castellanos, M., & Duran, P. (2010). Integrating nurse-directed diabetes management into a primary Care Setting. America Journal of Managed Care, 16(9), 652-656.
Lee, H., Ahn, S., & Kim, Y. (2009). Self-care, self-efficacy, and glycemic control of Koreans with diabetes mellitus. Asian Nursing Research, 3(3), 139-146.
Yoo, J., Lee, S., Lee, H., & Kim, M. (2007). The effect of a comprehensive lifestyle modification program on glycemic control and body composition in patients with type 2 diabetes. Asian Nursing Research, 1(2), 106-115.