Reflection on Learning week 7

WEEK 3

Analyze the evidence summary of the selected systematic review to address the following.

Does the research design answer the research question?

    The researcher of the selected article focused on the effects of the community-based program on type 2 diabetes mellitus prevention among the individuals in the low- and middle-income nations. To get answers to this question, the researcher adopted a systematic review and meta-analysis approach. There was an inclusion of the randomized controlled trials (RCT) with the program focused on the lifestyle changes for example the weight loss and the physical exercise without the inclusion of the pharmacological treatments. This was followed by at least 6 months follow-up that was performed in the low- and middle-income nations (Shrinzadeh, et al., 2019).

            Based on the above method, the researchers arrived at the answers concerning the role of the community-based program on type 2 diabetes mellitus. The study shows that the risk of developing type 2 diabetes mellitus among the intervention groups was reduced. There were also greater variations in the weight, body mass index, and the waist circumference change amongst the individuals in the community-based program from the baseline. Individuals in the intervention group also showed a greater reduction in fasting blood sugar and HbA1C measurements (Shrinzadeh, et al., 2019).

Were the study sample participants representative?

The sample is few and this is based on the smaller number of trials used, age, and the condition of the participants as well as the method used in delivering the intervention. This, therefore, means that the review failed to provide adequate through the use of the sample to represent the effects of the community-based intervention in the prevention of the type 2 diabetes mellitus in lower- and middle-income nations. The recruited participants were of ages ranging from 30 to 76 years, this, therefore, implies that the study outcome might not apply to the younger adults even though type 2 diabetes mellitus is not common among this age group (Shrinzadeh, et al., 2019).

Compare and contrast the study limitations in this study.

   The researchers performed their review based on the recommendations proposed in the Cochrane Handbook that guides on the systematic review of the interventions using a comprehensive literature search across the databases and two trial registries for the identification of the published as well as the unpublished trials. Nevertheless, the researchers failed to conduct a broader search of a gray literature. The researchers also limited the search results to English language literature. The researcher also had a plan of utilizing the funnel plots for the assessment of the possible publication bias in case at least 10 trials were included. However, the researcher with the presence of the limited number of randomized controlled trials (RCTs) i.e. six studies, it becomes difficult to ensure that there is a generation of a funnel plot to guide in the process of assessing the publication bias. Some of the trials that were included were smaller and they mostly described one-year follow-up while others failed to report on the outcomes of interest. The researchers also included a limited number of trials that were used to report on each outcome. This made it hard to perform the analysis of the subgroups (Shrinzadeh, et al., 2019).

Based on this evidence summary, would you consider this systematic review as support for your selected practice problem?

  The increase in the incidence of type 2 diabetes mellitus is having substantial effects on lower- and middle-income nations. One of the effective approaches that have been recommended to help in addressing the issue is the implementation of the community-based programs that are strictly addressing the behavioral interventions. Community-based program is addressing the issues of diet, physical activity, and healthy behaviors. These are some of the factors that have been considered to be influencing the rates of type 2 diabetes mellitus in the community, especially in the high-income nations. Nevertheless, such practices have not yet been fully implemented in the lower- and middle-income nations thus putting the population at high risk of type 2 diabetes (Shrinzadeh, et al., 2019).       

            Based on the pieces of evidence provided in this systematic review, it can be concluded that the community-based intervention is having great impacts on the lower- and middle-income countries in terms of the risk reduction of the certain modifiable risk factors of type 2 diabetes mellitus. The adoption of this program might be helpful in the reduction of the reported cases of type 2 diabetes mellitus and positive effect on the anthropometric indices and the glycemic control among individuals who are considered to be at high risk of type 2 diabetes mellitus (Shrinzadeh, et al., 2019).

References

Shrinzadeh Maryam, Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of community-based programs on diabetes prevention in low-and middle-income countries: a systematic review and meta-analysis. Globalization and health, 15(1), 1-13. doi:org/10.1186/s12992-019-0451-4