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Lifestyle Modification in the Management of Diabetes

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Lifestyle Modification in the Management of Diabetes

Type 2 diabetes is a common chronic disease in the United States, with a prevalence

estimated to affect more than 30 million people accounting for around 9.4% of the United States

population (Gillani et al., 2017). As time progresses, the number of individuals with this

condition continues to rise steadily, with a steady rate of 1.5 million American adults every year.

Prolonged exposure to diabetes can progress into many complications, including stroke and heart

disease, which arise from induced oxidative stress (Fink et al., 2019). Type 2 diabetes also

predisposes patients to microvascular complications such as neuropathy, retinopathy,

nephropathy, and kidney failure. Therefore, it is necessary to effectively determine an

intervention suitable for controlling the glycemic levels in those ailing from the condition.

Clinical Problem Statement

Diabetes imposes a momentous economic burden on families and society because it is

one of the most costly chronic diseases. According to statistical estimates, it required over $176

billion in direct medical costs alone annually (Aminian et al., 2019). Therefore, identifying

alternative approaches that patients can use to improve the quality of their life is essential in

reducing healthcare costs. The intensive lifestyle intervention will ensure high compliance rates

because patients will not incur excessive expenses while implementing them. They have to make

healthy choices by using the products they already have around their homes

Significance of the topic and its implication in the nursing practice

The significance of this topic is that it addresses an issue that is already affecting many

people. Therefore, developing an effective intervention will assist many people to understand

effective coping mechanisms and help the rest of the population with strategies to reduce their

susceptibility to the disorder (Taheri et al., 2020). The impact of this topic on the nursing

practice is that the medical practitioners will be able to accomplish their goals of producing a

healthy population that is ready to focus on building the economy and nation.

Purpose of the Change Proposal

The purpose of the change proposal is to determine the effectiveness of an intensive

lifestyle as an intervention for managing diabetes. The process includes compiling evidence that

determines whether lifestyle modification is an evidence-based practice that can be incorporated

into the clinical setting. The intervention will be implemented in the clinical setting to improve

the quality of care that patients receive. Afterward, it will be evaluated to determine its

effectiveness in reducing blood sugar levels in patients with T2D.

PICOT Question

The PICOT question that will be the focus of the change proposal is: In patients with type

2 diabetes, is making intensive lifestyle changes compared to using standard procedures only

effective in lowering blood sugar levels in thirty days? In this context, the patient population (P)

refers to patients with type 2 diabetes. On the other hand, the intervention (I) refers to the

intervention being investigated to determine whether it is an evidence-based practice that can be

applied in the clinical setting. In this case, it is intensive lifestyle modifications. The comparison

factor (C) in this study is the use of the typical techniques usually used in managing patients with

the condition, such as the use of pharmacological agents. The expected outcomes (O) refer to the

expected results realized in the clinical setting after the intervention is incorporated as part of the

treatment process. The anticipated outcome is a reduction in the blood sugar levels of those who

use the intervention. Consequently, time (T) refers to the duration that it will take before positive

outcomes are noted, which in this case is thirty days.

Literature Search Strategy

The strategy used to compile literature for use in compiling information on the study was

perusing online databases containing scholarly materials such as PubMed, CINAHL, and Ebcost.

The keywords and phrases used during the process included "lifestyle modification" and

"management of type 2 diabetes." The search yielded over thirty articles that discuss various

aspects of the topic. These write-ups were scrutinized further, and the eight most relevant ones

were included in the study.

Evaluation of Literature

Diabetes is a significant health problem that is prevalent in contemporary society. It is a

condition characterized by high concentrations of sugar in the blood precipitated by either

inadequate production of insulin or failure of the bodies of those affected to respond to the

hormone (Johansen et al., 2017). It is one of the leading causes of mortalities in the U. S.

Therefore, it is necessary to find adequate strategies for managing the condition to reduce its

prevalence in society.

Comparison of Research Questions

Aminian et al. (2019) hypothesized that using metabolic surgery to control the dietary

intake of obese patients who have diabetes will help to reduce the concentration of sugar in their

blood. The study would test whether this preposition was factual or whether the data that would

be compiled would yield contrary outcomes. On the other hand, the study conducted by Fink et

al. (2019) aimed to answer the research question: What are the challenges associated with Type 2

Diabetes, and what changes do individuals make to cope with the condition effectively? The

authors focused on compiling views from participants to compile content that would answer this

critical question.

Unlike Aminian et al. (2019) and Fink et al. (2019), Gillani et al. (2017) focused on a

single population in their investigation. They conducted research that aimed to answer the

research question: What lifestyle changes should physically disabled diabetes patients make, and

how do they impact their blood sugar levels? Similarly, Taheri et al. (2020) focus on a different

population often affected by high blood sugar levels. They used the research question: Does

implementing comprehensive lifestyle modifications positively impact young diabetic patients?

to explore the impact of lifestyle modification in the lives of patients diagnosed with the

condition at an early age. Another practical approach used to compile evidence on the strategies

that can help control sugar levels is identifying a specific lifestyle modification technique and

determining its effectiveness. For example, Hallberg et al. (2018) focused on answering the

research question: What impact does controlling carbohydrate intake in diabetic patients have on

glycemic control in patients with diabetes?

Comparison of Sample Populations

The authors use different sample populations to compile data on lifestyle changes, an

intervention that purposes to reduce blood sugar levels in patients with diabetes. While Aminian

et al. (2020) used a large sample size of over 13 722 patients, Huang et al. (2016) incorporated

only 16 participants. Using a large number of participants is a significant aspect of investigative

research. However, when using models such as qualitative studies, researchers often prefer to use

a limited study population because of limited funds and the need to compile comprehensive

information about a topic. However, all the studies were conducted in healthcare facilities which

increases the dependability of the compiled content because the studies were conducted by

experts in the medical field.

Comparison of the Limitations of the Studies

The studies exploring the efficacy of lifestyle changes in controlling the blood sugar

levels in diabetic patients have different limitations that affect their dependability. For example,

the possibility of the presence of errors such as coding errors, misdiagnosis, and

misclassifications are significantly high in the study conducted by Johansen et al. (2017) and

Aminian et al. (2019). Another significant limitation of the study is difficulties in confirming

whether high glycemic levels precipitated the fatality of patients with diabetes. Another

considerable limitation noted in the studies was the failure to incorporate diverse participants in

the investigative process. For example, Fink et al. (2019) and Hallberg et al. (2020) included

only participants from one region. This interfered with the generalizability of the study because

populations such as immigrants were not incorporated into the study. Gilani et al. (2017) also

explored a significant limitation experienced during the study. The lack of adequate funds

limited the number of participants who could be incorporated into the study. This element was

also noted in the research carried out by Taheri et al. (2019) and Sebire et al. (2018)

Applicable Change or Nursing Theory Utilized in the Project

The change model that is most suitable for implementing the changes in diabetic

management is Rogers' change theory. This is because the steps inherent in the change model

will ensure that the effectiveness of the planned changes is proven before they are adopted

(Hallberg et al., 2018). For example, during the awareness step, the healthcare providers will be

notified about the need to change the approaches used in managing diabetes in the clinical

setting.

Proposed Implementation Plan with Outcome Measures

The proposed will be implemented in the clinical setting by incorporating a change model in

the process. The first step that will take place during this process is creating awareness about the

need for change (Huang et al., 2016). The strategies that will be used during the process include

training the healthcare providers to instruct them on the need for this change. The next step

during the process will be stimulating interest in the issue among all the principal shareholders

The approach that will be used to assimilate the intervention into the clinical setting includes

changing the guidelines that nurses follow while managing patients with T2D to include

intensive lifestyle modifications as a vital process. The next step in the process is evaluating the

measures that have been put in place to transform the quality of care that patients receive from

the healthcare organization (Gillani et al., 2017). Different parameters will be gauged during the

process, including the number of fatalities that occur in the clinical setting due to the condition

and the changes in patients' medical costs.

The investigation will help unearth clinically significant materials that can be used in the

clinical setting as an evidence-based practice that will elicit positive outcomes in the clinical

setting. Clinically important data is that which is compiled from actual experimentations (Fink et

al., 2019). It differs from statistical significance because statistical inferences are derived from

secondary studies. Therefore, their margin of error is usually significantly higher than that of

clinical studies.

How Evidence-Based Practice was Used in Creating the Intervention Plan

Evidence-based practice can be used while creating the intervention plan by investigating

and using processes used in the past successfully. This approach can be applied by scrutinizing

studies conducted in the past and determining the evidence-based techniques that were applied to

implement interventions effectively (Johansen et al., 2017). Using this process is significant

because it ensures that the strategy used in the project is effective. It will determine the best

approach to use while implementing the project. It will also help by identifying the limitations

encountered while employing evidence-based practices to identify their possible solutions.

Potential Barriers to Implementation of the Plan and How they Could be Overcome

The barriers that may hinder the plan from being implemented effectively include a lack

of adequate skills on how it can be implemented effectively. The healthcare workers may not be

adequately equipped with the competency required to implement the plan effectively. For

example, they may lack the knowledge on the suitable foods that the patients should eat as part

of the intensive lifestyle change (Hallberg et al., 2018). Additionally, another hindrance to the

plan's implementation is the lack of adequate funds in the organization to fund the proposed

change. Lack of sufficient funds will hinder the organization from implementing the proposed

change and benefitting from its numerous benefits.

The strategies that can be used to overcome the challenges include planning for training

programs for the employees in readiness for the change. The additional training will equip them

with the skills they need to implement the project effectively. Also, it may be necessary for the

organization to seek additional funding by applying for government grants or loans from

financial institutions. The additional funds will ensure that all the expenses are catered to

promptly and that the project is implemented effectively.

Conclusion

The proposed project is a vital change proposal that will be fundamental in ensuring that

the quality of care that patients receive in the healthcare setting improves significantly. It will

enhance the standards of care used while managing patients with T2D to ensure that their

duration in healthcare facilities is reduced considerably and the cost they incur while seeking

treatment declines. Therefore, it is a significant project beneficial to all stakeholders in the

healthcare industry, including the patients, healthcare providers, and administrators of healthcare

organizations.

References

Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., ... &

Nissen, S. E. (2019). Association of metabolic surgery with major adverse cardiovascular

outcomes in patients with type 2 diabetes and obesity. Jama, 322(13), 1271-1282.

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The lancet, 389(10085), 2239-2251.

Fink, A., Fach, E. M., & Schröder, S. L. (2019). 'Learning to shape life'–a qualitative study on the

challenges posed by a diagnosis of diabetes mellitus type 2. International journal for equity in

health, 18(1), 1-11.

Gillani, S. W., Sulaiman, S. A. S., Abdul, M. I. M., & Saad, S. Y. (2017). A qualitative study to explore

the perception and behavior of patients towards diabetes management with physical

disability. Diabetology & metabolic syndrome, 9(1), 1-10.

Gummesson, A., Nyman, E., Knutsson, M., & Karpefors, M. (2017). Effect of weight reduction on

glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes, Obesity and

Metabolism, 19(9), 1295-1305.

Taheri, S., Zaghloul, H., Chagoury, O., Elhadad, S., Ahmed, S. H., El Khatib, N., ... & Abou-Samra, A.

B. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2

diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. The lancet

Diabetes & endocrinology, 8(6), 477-489.

Bi, S., Ding, X., Yu, S., Guo, B., Mu, L., & Wang, B. (2021). A machine learning model for quantifying

the effect of lifestyle interventions for patients with type 2 diabetes mellitus. In Journal of

Physics: Conference Series (Vol. 1732, No. 1, p. 012006). IOP Publishing.

De Vries, T. I., Dorresteijn, J. A., Van Der Graaf, Y., Visseren, F. L., & Westerink, J. (2019).

Heterogeneity of treatment effects from an intensive lifestyle weight loss intervention on

cardiovascular events in patients with type 2 diabetes: data from the Look AHEAD trial.

Diabetes Care, 42(10), 1988-1994.

Gregg, E. W., Chen, H., Wagenknecht, L. E., Clark, J. M., Delahanty, L. M., Bantle, J., ... & Look

AHEAD Research Group, F. T. (2012). Association of intensive lifestyle intervention with

remission of type 2 diabetes. Jama, 308(23), 2489-2496.

Huang, X. L., Pan, J. H., Chen, D., Chen, J., Chen, F., & Hu, T. T. (2016). Efficacy of lifestyle

interventions in patients with type 2 diabetes: a systematic review and meta-analysis. European

Journal of Internal Medicine, 27, 37-47.

Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., ... &

Ried-Larsen, M. (2017). Effect of an intensive lifestyle intervention on glycemic control in

patients with type 2 diabetes: a randomized clinical trial. Jama, 318(7), 637-646.

Schmidt, S. K., Hemmestad, L., MacDonald, C. S., Langberg, H., & Valentiner, L. S. (2020).

Motivation and barriers to maintaining lifestyle changes in patients with type 2 diabetes after an

intensive lifestyle intervention (The U-TURN Trial): a longitudinal qualitative

study. International Journal of Environmental Research and Public Health, 17(20), 7454.

Appendix Section

Appendix 1: The Literature Evaluation table

Criteria Article 1 Article 2 Article 3 Article 4

Author, Journal (Peer- Reviewed), and Permalink or Working Link to Access Article

Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., ... & Nissen, S. E. Published in Jama Journal. https://jama.jama network.com/arti cle.aspx?doi=10. 1001/jama.2019. 14231&utm_

Fink, A., Fach, E. M., & Schröder, S. L. Published in the International journal for equity in health. https://doi.org/10.1 186/s12939-019- 0924-3

Gillani, S. W., Sulaiman, S. A. S., Abdul, M. I. M., & Saad, S. Y. Published in the Diabetology & metabolic syndrome Journal. https://link.spring er.com/content/pd f/10.1186/s13098 -017-0257-6.pdf

Huang, X. L., Pan, J. H., Chen, D., Chen, J., Chen, F., & Hu, T. T. E. Published in European Journal of Internal Medicine. https://doi.org/ 10.1016/j.ejim .2015.11.016

Article Title and Year Published

Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. Published in 2019

Learning to shape life'–a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. Published in 2019

A qualitative study to explore the perception and behavior of patients towards diabetes management with physical disability. Published in 2017.

Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. Published in 2016

Research Questions (Qualitative)/H ypothesis (Quantitative)

Metabolic surgery controls dietary intake to manage blood sugar levels, and reduce the need for medication in diabetic patients who are obese.

What are the challenges associated with a diagnosis of T2D, and what changes do individuals make to cope with the condition effectively?

What lifestyle changes should physically disabled diabetic patients make, and how do they impact their blood sugar levels?

Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis

Purposes/Aim of Study

What lifestyle changes should

The study aims to deduce the health

The purpose of the study was to

The purpose of the meta-

physically disabled diabetic patients make, and how do they impact their blood sugar levels?

challenges associated with a diagnosis of T2D and the impact of making lifestyle changes on coping with them

determine whether physically disabled individuals with T2D were aware of the lifestyle management strategies such as changes in dietary intake that they should make to lower their blood sugar levels and improve their health and well- being and the impact of these changes.

analysis is to determine the outcomes of three lifestyle changes: dietary management, increased physical activity, and patient instruction on effective self- care

Design (Type of Quantitative, or Type of Qualitative)

Retrospective cohort design

Descriptive design Exploratory design

Meta- synthesis design

Setting/Sample

Cleveland clinic/ 13722 patients

Martin Luther-King University Hospital in Germany/ 19 participants

Penang Hospital in Malaysia/21 participants

Online research/ 17 articles

Methods: Intervention/In struments

Observation of selected patients

Semi-structured interviews using open ended questions

Semi-structured interviews using pen-ended questions

Review of the data in the articles

Analysis

Surgical restructuring of the digestive systems is directly linked to a reduction of blood sugar levels

Patients who changed their lifestyle to incorporate healthy habits experienced low blood sugar levels.

Increased physical activity in physically disabled patients with T2D is directly related to lower blood sugar levels.

Dietary management, increased physical activity and effective education of patients are directly linked to improved health in patients with T2D.

Key Findings

Surgical restructuring of the metabolic system helps reduce the prevalence of cardiovascular problems in obese patients who have diabetes. It also helps control blood sugar levels and reduce medication use in diabetic management

Patients with T2D investigated and found new strategies for coping with the challenges precipitated by a diagnosis of the disease. They also adopted new living styles to improve their health and well-being, which lowered their blood sugar levels significantly.

Patients with T2D investigated and found new strategies for coping with the challenges precipitated by a diagnosis of the disease. They also adopted new living styles to improve their health and well- being, which lowered their blood sugar levels significantly.

Lifestyle modification played a significant role in lowering blood sugar levels and improving the health and well-being of patients with diabetes.

Recommendati ons

The surgical procedure was a practical approach to improving the lifestyle of diabetic patients who are obese. It led to better dietary management and helped lower the blood sugar levels of patients

Healthcare providers should educate patients on the effective lifestyle changes they can make to improve their health and well- being.

It is necessary to instigate measures to help T2D patients with physical disabilities make adequate lifestyle changes for effective glycemic control

The authors recommended that lifestyle changes should be instructed in diabetic patients to promote their health and well-being.

Explanation of How the Article Supports EBP/Capstone Project

The article is related to the PICOT question because it identifies metabolic surgery as a preparatory step that can be used to change the lifestyle of a diabetic patient to reduce the portions of food they consume

The article is related to the PICOT question because it determines the changes individuals are compelled to make after they are diagnosed with T2D and the impact of these lifestyle changes on their health and well- being.

The article relates to the PICOT question because it explores the lifestyle modifications that diabetic patients who are physically incapacitated make to improve their health and well-being

The article relates to the PICOT question because it discusses practical lifestyle modification approaches that diabetic patients can use and their impact on their blood

and reduce weight, hence controlling their blood sugar levels.

sugar levels.

Criteria Article 5 Article 6 Article 7 Article 8

Author, Journal (Peer- Reviewed), and Permalink or Working Link to Access Article

Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., ... & Ried-Larsen, M. Published in Jamanet Journal. https://jamanetwor k.com/journals/jama /article- abstract/2648632

Taheri, S., Zaghloul, H., Chagoury, O., Elhadad, S., Ahmed, S. H., El Khatib, N., ... & Abou-Samra, A. B. The Lancet Diabetes and Endocrinalogy Journal. https://jamanetwo rk.com/journals/ja ma/article- abstract/2648632

Sebire, S. J., Toumpakari, Z., Turner, K. M., Cooper, A. R., Page, A. S., Malpass, A., & Andrews, R. C. BMC Public Health Journal. https://bmcpublic health.biomedcen tral.com/track/pdf /10.1186/s12889- 018-5114-5.pdf

Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., ... & Volek, J. S. Diabetic Therapy Journal. https://link.spr inger.com/arti cle/10.1007/s1 3300-018- 0373-9 .

Article Title and Year Published

Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Published in 2017.

Effect of intensive lifestyle intervention on body weight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Published in 2020

"I've made this my lifestyle now": a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus. Published in 2018.

Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open- label, non- randomized, controlled study. Publised in 2018

Research Questions (Qualitative)/H

How does lifestyle modification impact the

Does implementing comprehensive

How do people newly diagnosed with diabetes get

What is the impact of controlling

ypothesis (Quantitative)

glycemic levels of diabetic patients?

lifestyle modifications have a positive impact on young diabetic patients?

the motivation needed to make positive changes in their lifestyle and the impact of these changes on their blood sugar levels

carbohydrate intake having on glycemic control?

Purposes/Aim of Study

The study purposed to investigate the hypothetical indication that modifying patients' lifestyles helped improve their glycemic levels, lowering their need for medications.

The study aims to investigate whether encouraging lifestyle modifications can help young people with T2D to lose excessive weight and have sufficiently low glycemic levels.

The study aims to determine how individuals diagnosed with T2D get encouraged to make lifestyle changes to control their sugar levels and the impacts of this decision

The purpose of the study is to determine the impact of an intervention designed to restrict carbohydrate intake on the sugar levels of diabetic patients

Design (Type of Quantitative, or Type of Qualitative)

Quasi experimental design

Exploratory study design

Descriptive research design

Randomized control design

Setting/Sample

Zealand and Denmark/98 patients

Qatar/ 158 participants

South West England/ 593 participants

Lafayette, Indiana/218 participants

Methods: Intervention/In struments

Comparison of the two variables

Semi structured interviews

Comparison of dependent and independent studies

Analysis

Lifestyle changes are directly related to the intensity of the lifestyle changes patients make.

There is a direct connection between healthy lifestyles and low glycemic levels

Key Findings

Making lifestyle changes reduced the glycemic levels of diabetic

Lifestyle modifications helped reduce excessive weight,

The diagnosis of diabetes is a significant motivation that

Limiting carbohydrates intake is a significant

patients; hence they took fewer drugs to control the disease.

which is a significant factor in diabetes control. It also reduced glycemic levels hence improving the health of the patients.

makes them make adequate lifestyle changes to control their blood sugar levels

intervention that helps in lowering glucose intake in patients with T2D

Recommendati ons

The authors recommended that diabetic patients be encouraged to make lifestyle changes to improve their health and well-being.

Lifestyle modification should be encapsulated as an effective strategy in managing diabetes because of its short-term and long-term benefits to the patients.

It is significant for individuals diagnosed with T2D to have adequate motivations to make them change their lifestyle, which is a necessary process that ensures that their blood sugar levels are controlled adequately

The researcher indicated that the issue should be investigated more to determine the strategies that can be used to adapt the intervention as an evidence- based practice in the clinical setting

Explanation of How the Article Supports EBP/Capstone

The article is related to the PICOT question because it investigates the relationship between making lifestyle changes and reducing blood sugar levels in diabetic patients and how this impacts their medication use.

The article relates to the PICOT question because it examines the impact of modifying lifestyle on controlling glycemic levels and weight and improving the well-being of patients with diabetes

The article relates to the PICOT question because it investigates how the impacts of making lifestyle changes such as dietary changes and engaging in physical exertions can improve the quality of life of a diabetic patient.

The article is related to the PICOT article because it scrutinizes the effects of using a lifestyle model that comprises approaches such as limiting the intake of carbohydrates in patients with T2D.