homework

PRACTICE GUIDELINES 14

Part 1 – Organization

For the body paragraphs, consider beginning each with a topic sentence that tells the reader the main idea of the paragraph. The other sentences then provide support for the topic sentence. This creates cohesion within and between paragraphs. To keep the paragraphs from ending abruptly, consider adding a concluding sentence that states the key point the reader should have learned from the paragraph.

Part 2 – Development

I made comments in green places where you might clarify or further elaborate on a point being made about the existing guidelines on managing and treating diabetes. There were some places where you might want to elaborate on a points being made to ensure the reader comprehends the points that you are making about the recommendations and where there may need to be revisions. Regarding word choice, I made comments in purple places where the wording caused the sentence to read awkward; there was wordiness that might distract the reader; or the wording sounded less formal in tone. You simply want to consider rephrasing those sentences.

Part 3 – Formatting and Style

You indicated in the task request that your paper format is APA style. I indicated in blue font places where I found an issue with the formatting or style requirements. Under useful links is a link to a condensed version of the APA guidelines that may assist with revisions. There is a link inside of the document that provides a sample essay properly formatted if you need a visual.

Critiquing Diabetes Clinical Guidelines

12/01/2021

[the heading Abstract is centered in bold font at the top of the page and is not in all capital letters. Also, the abstract paragraph is not indented in APA Style]

ABSTRACT

Diabetes is a chronic disease that has been on the rise for the past two decades[review grammar guide rules on comma usage; is the comma needed here.], with the type-2 [whole numbers less than eleven are written out in wording rather than using the Arabic numeral as you have in this sentence; check for this issue other places in the paper.] variant being the most common. Physicians and nurses need to be updated with the latest research on diabetes for them to be able to diagnose and treat the ailment in the best possible way while maintaining patient trust, confidence, and comfort. The clinical guidelines for diabetes are regularly updated, but some guidelines need to elaborate further to minimize the grey area in diagnosis and treatment. This article analyzes the different diabetes variants and the practice guidelines available while minimizing the grey areas. This was done through research of various scholarly articles and comparing different findings from other diabetes research. This research concludes that medical costs for diabetes being high is a major deterrent for people with diabetes to get adequate health care and that all stakeholders have to work together in unison in research to come up with better guidelines and treatment methods.

[The title of the paper is centered in bold font at the top of the first page of text after the abstract. Additionally, the first section of the paper is assumed to be the introduction in APA, so no heading is included for the introduction]

Introduction

Recommendations on the diagnosis, treatment, physical support, rehabilitation, and follow-up care that every medical practitioner follows are contained in the clinical guidelines. These guidelines are there to protect patients and ensure that they receive the best and appropriate treatment and care. These guidelines should be updated regularly because diseases and the health system are rapidly changing, and new evidence about diseases is being found. Diabetes is a common disease in the U.S., and it affects about 10.5% of its population, and it also has guidelines recommended for its diagnosis and treatment (National Diabetes Statistics Report, 2020). These guidelines have their strengths and weaknesses and become outdated as time passes. Some clinical guidelines may lack enough bases for their inclusion in guidelines, so they are not needed. This article seeks to inform medical providers about diabetes, unearth and challenge information and guidelines concerning diabetes, and evaluate the outcome of the analysis on the guidelines about diabetes.

Diabetes

Diabetes is a chronic disease that sees its genesis from either the pancreas producing less insulin or the body not using the insulin produced effectively (Mandal, 2021). It is under the category of endocrine illnesses. Insulin is a hormone that is responsible for regulating blood sugar levels. There are three types of diabetes type 1 diabetes, type 2 diabetes, and gestational diabetes. Type 1 diabetes is caused by the immune system attacking cells of the pancreas beta cell, which is responsible for producing insulin; type 2 is caused by the body being resistant to insulin, affecting the sugar level. Gestational diabetes is a pregnancy complication where the placenta produces insulin blocking hormones, leading to high sugar levels in the mother's body (Mandal, 2021). There is also a condition referred to as pre-diabetes, where the blood sugar is higher than normal but not as high to be diagnosed as type 2 (Mandal, 2021). Almost 30% of people in the U.S. have pre-diabetes and are at risk of getting diabetes (National Diabetes Statistics Report, 2020). The lifestyle choices of people living in the U.S. are the major factor influencing the high rate of diabetes and diabetes-related illnesses (Hill-Briggs et al., 2020).

Diabetes is ranked as the seventh disease that causes most deaths in the U.S., with almost 11% (34.2 million) of its population being diagnosed with it, and about 4.3% have it but have not been diagnosed (National Diabetes Statistics Report, 2020). The prevalence of diabetes in seniors above 65 years and above was 14.3 million, and it is reported to have 1.5 million new cases every year (National Diabetes Statistics Report, 2020). Two hundred and ten thousand Americans under the age of 20 years are estimated to be diagnosed, which is approximately 0.25% of the population. The state with the lowest diabetic rate is Colorado at 7%, and the highest is West Virginia at 15.7% (Bertoni et al., 2017).[to keep body paragraphs from ending abruptly, some writers will end with a concluding sentence that states the key point the reader should have learned reading the paragraph. Consider creating a concluding sentence at the end of each body paragraph.]

In 2019, diabetes was the ninth leading cause of death in the world, with more than 79,000 deaths annually. In addition, there was an increase of premature mortality from 2000 to 2016 by 6%. Diabetes also increases the risk of other medical conditions such as blindness, kidney failure, heart attacks, and lower-limb amputations. [this paragraph seems to also provide more statistics about the mortality rate, so could this be incorporated in the previous paragraph, so you don’t have a short paragraph of three sentences]

Certain factors make the risk of acquiring diabetes even higher. For example, having excess weight where the body is full of fatty tissue makes it more resistant to insulin. Race and ethnicity are also added factors where certain races tend to get diabetes easily.[you might explain which races and ethic groups are more at risk for developing diabetes. Also, if there are ones that are more likely to develop a specific type, you might indicate that as well here] In addition, family history, age, high blood pressure, history of gestational diabetes[do you mean if there is a history of this form of diabetes in the family?], inactivity, and polycystic ovary syndrome are among the risk factors for diabetes.[you might elaborate on how these are risk factors for diabetes. For example, what about age makes one more at risk?]

Practice Guidelines

Practice guidelines are rules on how to diagnose and treat an illness. These rules are mainly written for doctors, but nurses and other medical practitioners can also use them. Diabetes also has criteria that have been put in place that needs to be followed. Doctors should look for Diabetes in case the patient shows symptoms of the disease, have cardiovascular disorders like stroke, myocardial infarction, hypertension, peripheral neuropathies, foot ulcers, absence of tendon reflexes, or peripheral pulse[clarify what you mean about peripheral pulses. Is it an absence or diminished pulse or something else?]. For diagnosis of the medical condition, the patient must have symptoms of Diabetes which are increased thirst, increased urine, and unexplained weight loss (Standards of Medical Care in Diabetes, 2019). They should also undergo a fasting blood sugar test which, if the results show that the patient's sugar level was above 126mg/Dl, confirms the disease's presence. They should also have hemoglobin AC1 higher than 6.5% (Standards of Medical Care in Diabetes, 2019).

Treatment Guidelines

[to help with cohesion and flow within the body paragraphs, most writres will begin with a topic sentence that indicates the main idea of the paragraph, and the other sentences should support the topic sentence. IF you are writing about the treatment guidelines for someone once diagnosed, introduce the idea in the topic sentence. The other sentences can then explain what the various treatment guidelines are in more detail]For treatment of the ailment, the physician should see that the fasting blood levels are less than 8.3mmol/liter, and the blood glucose levels should not fall below 4.5mmol/liter.[you might explain why this is an important treatment to carry out for a patient] In addition, the patients should also be advised on dietary and lifestyle matters where the criteria state that the patients should avoid sugared foods, take foods with high fiber while limiting foods with fat and alcohol, increase physical activities or indulge in physical exercise, stop smoking and the weight of the patient should be reduced by 5-10% and maintained at this level. [you might break this up into several sentences for each treatment option and also explain why this is an appropriate recommendation for patients diagnosed with this disorder.]

Pharmacological Treatment[should both words be capitalized in the heading]

The first line of treatment should be metformin which should be administered for two weeks[how often should they take it in the first two weeks]. In the second week, the medication should be taken in the morning and the evening after meals.[you might explain why after meals is important] If glycemic control is not achieved, then sulfonylurea should be added to the medications. Patients' age matters, and for patients who are under 60 years, they should be given glipalamide, while patients over 60 years should be given gliclazide.[should you explain why this is the case] Intermediate-acting insulin should be introduced if a combination of metformin and sulfonylurea does not achieve glycemic control.

Surveillance and Monitoring

[consider a more concise topic sentence for the paragraph to help increase cohesion. If you are writing about monitoring, make this clear in the topic sentence]The guidelines also give way forward for when a patient leaves the confines of a hospital. If a patient is on hypoglycemic agents, they should have blood glucose tests at least once every month [review comma usage rules; is a comma needed here]then when going for monitoring visits while those patients on insulin should have fasting glucose test during the dose adjustment phase then after that once a week (Standards of Medical Care in Diabetes, 2019).[consider rephrasing the previous sentence into a couple of sentences because it is unclear the different points you are making about when the fasting glucose tests should be done.] The patients should also go for routine check-ups to examine their blood pressure, weight, and feet[you might indicate what is meant by routine. Is it every 90 days, six months, etc.?]. Management of diabetes complications should also be handled.[should you elaborate on what this would entail specifically] The patients should also be taught how to monitor themselves and taught about the different therapies they are undergoing, such as insulin therapy (Standards of Medical Care in Diabetes, 2019). [should you elaborate on this point in more detail. You might even consider creating one paragraph that focuses on complications and a separate one on therapies.]

The guidelines are more specific in issues about medication and the quantities that are required to be given to patients.[should you explain what these are in more detail? They also touch on various issues that become a barrier to effectively diagnosing and treating patients.[should you discuss this in more detail] Technology has also been added to the equation as more technological upgrades happen in the healthcare system. [should you discuss this in more detail?]

[you might consider creating a separate paragraph for each of the three issues that you name in this paragraph and provide more detail on what the specific guidelines are. ]

Critiquing the Practice Guidelines While Improving on Other Guidelines

[consider a more concise topic sentence here. If you are writing about who is responsible for developing the guidelines, this should be clear in the topic sentence, and the other sentences in the paragraph should support the topic sentence]The guidelines put in place are evidence research-based, and they have been approved after a series of tests. They are all put in place for earlier detection of the disease, earlier diagnosis, and the best treatment from studies. Guidelines are produced by a committee of stakeholders with experience related to the health-related problem. This committee tries not to be biased, and if one of them becomes biased because they are affiliated to one of the entities that they will be collecting data, then their views are done away with. The committee then reconvenes once they have collected evidence-based data and compile them while discussing and analyzing them. Through their analysis, they can develop a clear guideline that can be used as a consistent basis to diagnose and treat diabetes.

The criteria for diabetes were developed to help physicians to[do you need the word to here; does it alter the meaning if removed from the sentence?] know when there is a presence of a disease. The symptoms that are given and acknowledged by the guidelines are the main symptoms and are mainly associated with diabetes. These symptoms and an array of tests available can be used to determine the presence of the disease. For example, the AC1 test confirms the fasting blood sugar levels in the blood, which is a more accurate way of confirming the diagnosis. The criteria also set how the patient should be treated while considering the patients' health history, risk factors, and other ailments that the patient might be suffering from (Carls et al., 2017). The patients' comfort is also put into the guidelines to ensure that the patients' minds and bodies are committed to the treatment. [consider a concluding sentence for the paragraph][you already presented the information that you have in this paragraph, so it seems redundant. If you are to critique if the guidelines are effective or appropriate, you want to make it more clear that this is what is being done in the paragraph]

The guidelines also offer information on what to do when the patients have been discharged from the hospital. After being discharged, patients will continue to undergo medication, and it is only fair to teach them about various therapies and what to do when the patient is no longer in the hospital but continuing medication at home. Healthy food habits are among the lessons that the patients will undergo together with recommendations of physical exercise. The guidelines also provide that patients should stop smoking as it is a risk factor.[you have the same issue in this paragraph as the previous one.]

All the above evidence suggests that guidelines are credible. Physicians are given a clear directive by the guidelines on how to diagnose and treat patients. The patients are also included in their recovery, where they are educated about their ailment and how they can manage it. This method effectively manages diabetes as it encompasses information from many sources and incorporates it into all the areas that will need to be taken care of when treating a patient.

Analysis

The world is rapidly changing, and so is the human capability to diagnose and treat diseases. This has been enhanced by research and development in technology which is now helping us solve many issues in the healthcare system. The guidelines will need to be revised at one time because of these changes.

The current guideline says that eating patterns[should you specify what the eating patterns are] are acceptable for persons with pre-diabetes. This should be revised since they do not restrict the scope of eating. Eating fatty or sugary foods during pre-diabetes increases the risk of acquiring diabetes. The statement should be rephrased to state that a variety of eating patterns can be considered to prevent diabetes in individuals with pre-diabetes. This statement restricts the patient to a meal plan that will not expose them to diabetes.

Another area of concern that will come up in the future relates to technology. The current guideline states that based on patient preference, technology-assisted diabetes prevention interventions may effectively prevent type-2 diabetes, and it should be considered. For example Libre is device placed on the arm and it instantly provides blood glucose reading. This should be re-evaluated since new technology is being developed uncontrollably. The control of technology to assist provider endeavors success for humankind. Losing control technology jeopardizes providers fate. In medicine, any technology that will assist physicians in monitoring and treating patients needs to have some kind of control (Standards of Medical Care in Diabetes, 2021).

The current guidelines also offer that the social and financial context of patients be looked into. However, sometimes this is not enough, as full details about the social lifestyle should be considered to get a broader picture (Hill-Briggs et al., 2020). This information is necessary to know the social support that the patient might get, the financial background to afford check-ups, and even the ability to give proper shelter to themselves (Smyth et al., 2020). Therefore, the guideline should state that providers should assess the housing insecurity, food insecurity, social support, financial barriers, and social capital and use that information to help the patient.

Research shows that patients with prescribed antipsychotic medication can show symptoms of pre-diabetes or diabetes. The current guideline gives the directive of them going for screening a year after starting to take the antipsychotic medications. It would be better to pull the first screening closer than one year because of the risk factor associated with diabetes (Standards of Medical Care in Diabetes, 2021). The guideline should state that for people who have been prescribed atypical antipsychotic medication, screening for diabetes and pre-diabetes should be done 4 months after medication initiation and at least annually after that.

The guidelines also offer critical times when there is a need to evaluate a patient on the outpatient skills, and they were taught to evaluate themselves (Talley, 2018). These times are at diagnosis, annually when they are not meeting treatment targets, when complicating factor development, and when transitions in care occur. These times are critical to a patient's treatment, and they should also consider adding a period when the patient's life is in transition. Moving from the norms will make a patient make specific lifestyle changes that might affect their treatment and cause complications of diabetes (Standards of Medical Care in Diabetes, 2021).

Evaluation

The revised guidelines need to be evaluated on their effectiveness and credibility before being completely absorbed into the clinical guidelines. Various steps need to be followed to qualify them as being effective. The starting point is framing a hypothesis as per the objectives of the main theme of the research body, which is commonly known as a research hypothesis. We will first create a research hypothesis on all the revised guidelines where the results of the previous guidelines will be compared to the revised guidelines. For example, the inclusion of life transitions in the four critical times to evaluate the need for self-management education increases the overall care for patients compared to the previous guideline where it was not included.

After formulating the research hypothesis, the next step consists of making a corresponding null hypothesis (a statistical hypothesis which (i) can be tested for its validity, i.e., Acceptance/rejection and (ii) is more popularly known as a hypothesis of zero difference or no difference. The research will need to be undertaken and the data collected fit into the statistical hypothesis. It is a basic yes or no question that creates an avenue for collection review of data. This will either affirm or deny the hypothesis set.

Thereafter, the next point of concern is selecting and using the most appropriate statistical test like the t-test, the z-test, the F-test, the chi-square test, for testing the statistical significance or insignificance of the observed result based on acceptance/rejection of the null hypothesis; to find out as to whether the observed result is a real one "or" it is only due to some chance/error factor. This analysis will help us get a better insight into the reality of the data collected. When the calculated test statistic (t/z/f/ chi-square) is less than the corresponding table value, then it is not significant, and we can accept that the null hypothesis while when the calculated test statistic is equal to or greater than the corresponding table value, then the signs and we shall reject the null hypothesis.

The last and final step consists of deriving the final result in terms of validity/invalidity of the research hypothesis leading towards acceptance/rejection of postulated research theory. The result obtained from the statistical tests will be the final judge whether the revised guideline is better or we should stick to the previous guideline.

The validity of the guidelines can also be gotten using another way. First, the revised guideline will be used by a particular chosen group of physicians. They should practice as the guidelines say. Second, we should realize that not all guidelines that will be revised will be having the same impact, and the physicians included in the research will attest to this as they give different information about the various guidelines. Third, the data gotten from the physicians on the credibility and effective use of the guidelines will be the data that will be used as evidence-based research that is needed in the health care system.

Conclusion

Diabetes is a chronic disease that requires a lot of research to effectively reduce the amounts of deaths that we encounter every year because of it. The practice guidelines for diabetes have been regularly revised by various entities in the world, such as the World Health Organization, American Diabetes Association, and the Center for Disease Control. These bodies are the backbone of the health system. They continually assess the effectiveness of the guidelines and give physicians recommendations on the best practices and medications that have come up. Physicians can also come up with their criteria, but they should follow the basics that larger organizations offer to promote uniformity in the healthcare system. The different types of diabetes need to be researched extensively to not mistake one for another. The prevalence of type 2 is alarming, and it calls for various stakeholders such as the government to sensitize people about healthy habits. The average cost of medication for diabetes alone is high, and these resources could be channeled elsewhere if the continued growth of diabetes in the U.S. can be controlled.

References

Aynalem, S., & Zeleke, A. (2018). Prevalence of Diabetes Mellitus and Its Risk Factors among Individuals Aged 15 Years and Above in Mizan-Aman Town, Southwest Ethiopia, 2016: A Cross Sectional Study. International Journal Of Endocrinology, 2018, 1-7. https://doi.org/10.1155/2018/9317987

[Here is a template for an article from a journal in APA Style:

Last Name, First Initial of Each Author. (Year Published). Title of the article with only the first word in the title, subtitle and proper nouns capitalized. Title of the Journal, Volume Number (Issue Number), page numbers. https://xxxxx

Bertoni, A., Krop, J., Anderson, G., & Brancati, F. (2017). Diabetes-Related Morbidity and Mortality in a National Sample of U.S. Elders. Diabetes Care, 25(3), 471-475. https://doi.org/10.2337/diacare.25.3.471

[see earlier template for a journal article]

Carls, G., Huynh, J., Tuttle, E., Yee, J., & Edelman, S. (2017). Achievement of Glycated Hemoglobin Goals in the U.S. Remains Unchanged Through 2014. Diabetes Therapy, 8(4), 863-873. https://doi.org/10.1007/s13300-017-0280-5

[see earlier template for a journal article]

Hill-Briggs, F., Adler, N., Berkowitz, S., Chin, M., Gary-Webb, T., & Navas-Acien, A. et al. (2020). Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care, 44(1), 258-279. https://doi.org/10.2337/dci20-0053

[see earlier template for a journal article]

Introduction: Standards of Medical Care in Diabetes—2021. (2020), 44(Supplement 1), S1-S2. https://doi.org/10.2337/dc21-sint

[I am not sure what type of source (journal article, website, etc.) the above citation is, so it is not clear if it is formatted properly. Look at the last section on the APA Guide, 7th edition under useful links on my summary response form. There are examples of the most common types of sources that you can compare to and be certain this is formatted properly.]

Mandal, A. (2021). Diabetes Pathophysiology. News-Medical.net. Retrieved 13 November 2021, from https://www.news-medical.net/health/Diabetes-Pathophysiology.aspx.

[Here is a template for a webpage from a website in APA Style:

Last Name, First Initial of Each Author. (Year Published). Title of the webpage with only the first word in the title, subtitle and proper nouns capitalized. Title of the Website. https://xxxxxx

National Diabetes Statistics Report, 2020. Centers for Disease Control and Prevention. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.

[The CDC is considered the author for this source, so in the intext citations in the body of the paper, the CDC should be provided as the name of the author rather than the title.

[here is a template for a webpage from an organization’s website with it as the author:

Name of the Organization. (Year Published or n.d.). Title of the webpage with only the first word in the title, subtitle and proper nouns capitalized. https://xxxxx

Smyth, A., Jenkins, M., Dunham, M., Kutzer, Y., Taheri, S., & Whitehead, L. (2020). Systematic review of clinical practice guidelines to identify recommendations for sleep in type 2 diabetes mellitus management. Diabetes Research And Clinical Practice, 170, 108532. https://doi.org/10.1016/j.diabres.2020.108532

[see earlier template for a journal article]

Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers. (2018), 37(1), 11-34. https://doi.org/10.2337/cd18-0105

[I am not sure what type of source (journal article, website, etc.) the above citation is, so it is not clear if it is formatted properly. Look at the last section on the APA Guide, 7th edition under useful links on my summary response form. There are examples of the most common types of sources that you can compare to and be certain this is formatted properly.]

Talley, M., Polancich, S., Williamson, J., Frank, J., Curry, W., Russell, J., & Selleck, C. (2018). Improving Population Health Among Uninsured Patients with Diabetes. Population Health Management, 21(5), 373-377. https://doi.org/10.1089/pop.2017.0170

[see earlier template for a journal article]