My topic is diabetes mellitus type 2: prevention, and please use the resources from the attachment I uploaded on diabetes. There is other resources listed in there that you can use as well. Let me know if you have any questions.
PICOT is an acronym used to help develop clinical research questions and guide you in your search for evidence. Finding the right answers requires the right questions. The PICOT format will help you construct questions that will likely lead to effective searches, the best available evidence of interventions, and the meaningfulness of patient experiences.
P = Patient population
I = Intervention or issue of interest
C = Comparison of interventions or comparison of interests
O = Outcome
T = Time frame (this element is not always included)*
For example, you may wish to research the effects of interrupted sleep on cognition of ICU patients 65 or older.
Using this PICOT model,
In __________(P), how does __________ (I) compared to _________ (C) influence _________ (O) over ________ (T)?
In ICU patients who are 65 or older, how does interrupted sleep (awakened one time or more in four hours) as compared to uninterrupted sleep influence the patient’s cognitive ability over 5 days?
Questions of meaningfulness and effectiveness relate to how people experience an intervention or phenomenon.
What is the effectiveness of using a turn schedule (I) versus an audible public address reminder (C) on the incidence of pressure ulcers (O) in elderly patients in LTAC who require turning (P)?
*Not all studies will have a time frame. This is optional to include as part of your PICOT.
Assignment Directions
Begin by selecting a
topic in nursing
that is of interest to you. Next, use PICOT to format a possible research question about that topic. Provide 1 possible PICOT research question. Find 1 quantitative or qualitative peer-reviewed research article related to your nursing topic that was published within the last 5 years. Reminder: All peer-reviewed research articles have methods, discussion, and results sections. Upload the article with your paper in PDF or Word format. This source can be used again in the Week 4 article assignment if it meets the criteria.
See
PICOT Formatting Guide
Download PICOT Formatting Guide
or pages 249-257 in your book for additional help with formatting your PICOT.
Include the following:
Title page
Provide a brief description of the topic and background information (see page 37 of your textbook). You can use your text, your peer-reviewed journal source, or the
EBP care sheets
in CINAHL or Nursing Reference Center Database.
Explain the significance of the topic to nursing practice (see chart on page 37 of your textbook). Background information can be found in journal articles in the introduction section. Results and conclusions will speak to significance of the topic. The EBP care sheets may have sources for you to choose from.
Provide 1 clearly-stated PICOT question.
Include 1 peer-reviewed journal source related to your topic.
The chosen topic and PICOT will be used for your Week 9 poster assignment. It will also guide your article searches in Week 4 on which you will complete appraisals in Week 6.
EVIDENCEBASED CARE
SHEET
Diabetes Mellitus, Type 2: Prevention
What We Know
› Diabetes mellitus, type 2 (DM2; formerly called non-insulin dependent diabetes and
adult-onset diabetes) is a chronic, multisystem metabolic syndrome of gradual onset
characterized by hyperglycemia caused by insufficient body tissue response to insulin
(i.e., insulin resistance) and impaired pancreatic production of insulin. Microvascular
disease is commonly present at diagnosis, and serious complications (e.g., cardiovascular
and renal disease) occur even in patients with DM2 who receive intensive treatment for
DM2. (1,5,12) (For more information, see Quick Lesson About … Diabetes Mellitus, Type
2)
• The rapidly increasing prevalence of DM2 is believed to be a result of lifestyle-related
changes in diet and physical activity(21)
–The World Health Organization reports an estimated 422 million adults living with
diabetes in 2014 which is 8.5% of the adult population(21)
– In 2018, an estimated 34.5% of adults, or 88 million individuals, in the United
States had “prediabetes,” (5) which is defined as impaired fasting glucose (IFG; i.e.,
fasting plasma glucose of 100–125 mg/dL), impaired glucose tolerance (IGT; i.e.,
2-hour plasma glucose value after a 75-gramoral glucose tolerance test [OGTT] of
140–199mg/dL); and/or elevated glycosylated hemoglobin (HbA1c; 5.7–6.4%)(1)
– Persons with prediabetes are at relatively high risk for developing DM2(15)
› The American Diabetes Association (ADA) recommends screening for DM2 and
prediabetes beginning at age 45 or earlier in patients who are overweight or obese (i.e.,
body mass index [BMI] ≥ 25 kg/m2) and have one or more additional risk factors for
ICD-10
E11
Authors
Helle Heering, RN, CRRN
Cinahl Information Systems, Glendale, CA
Jeanne Parks-Chapman, RN, BSN
Cinahl Information Systems, Glendale, CA
Reviewers
Teresa-Lynn Spears, RN, MSN
Cinahl Information Systems, Glendale, CA
Alysia Gilreath-Osoff, RN, MSN
Cinahl Information Systems, Glendale, CA
Nursing Practice Council
Glendale Adventist Medical Center,
Glendale, CA
Editor
Diane Hanson, MM, BSN, RN, FNAP
DM2.(1)The U.S. Preventive Services Task Force (USPSTF) recommends screening of
overweight and obese adults aged 40–70 years for abnormal blood glucose as part of
cardiovascular risk assessment (9)
• Risk factors include having a first-degree relative with DM2, low high-density
lipoprotein (HDL) cholesterol, elevated triglycerides, elevated BP, cigarette smoking,
physical inactivity, polycystic ovary syndrome (PCOS), history of gestational diabetes,
having given birth to a baby weighing > 9 lb, and being a member of certain ethnic or
racial groups (e.g., Black, Hispanic, Native American, Pacific Islander)(1,12,15)
› Researchers in several studies have demonstrated that onset of DM2 can be prevented
or delayed in patients with prediabetes by instituting lifestyle changes and/or using
pharmacologic agents or surgery(2)
• There is a lack of evidence, however, demonstrating that delaying onset of DM2 delays
onset of DM2 complications, compared with treatment once DM2 is diagnosed
› Primary DM2 prevention strategies focus on achieving and maintaining normal weight,
BP, and blood lipid levels through lifestyle modification that includes eating a healthy diet
and regular participation in physical exercise(2,15)
• The ADA recommends that patients with prediabetes participate in a program with the
goal of weight loss of 7% of body weight and an increase in physical activity to at least
150 minutes per week of moderate activity (e.g., walking).(2)The USPSTF recommends
July 16, 2021
Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2021, Cinahl Information Systems. All rights
reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by
any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice
or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206
that overweight and obese adults ages 35-70years, with additional cardiovascular risk
factors—such as prediabetes—receive effective preventive interventions(19)
– In the Diabetes Prevention Program (DPP), which enrolled overweight patients with prediabetes, weight loss and
increased physical activity reduced risk for new-onset DM2 by 58% at 3 years and was more effective in reducing risk
for progression to DM2 than the antidiabetic drug metFORMIN(16)
– In DPP, each kilogram of weight loss was associated with a 16% reduction in DM2 risk(16)
• Adherence to lifestyle modification requires substantial patient motivation promoted through education and consistent
clinician follow-up (6)
–Technology-assisted tools can assist patients in making effective lifestyle modifications(1,20)
– Researchers of a meta-analysis evaluating technology-mediated diabetes prevention interventions targeting diet and
exercise report an average of 3.76 kg of lost weight and significant glycemic improvement in participants(4)
– A systematic review of 19 studies reported that behavior change techniques in technology-driven DM2 prevention
interventions led to significant outcomes including at least 3% loss of baseline body weight at one year, improvements
in HbA1C and fasting glucose levels, and a lower 5-year incidence rate of DM2 (20)
› Dietary changes associated with lowered DM2 risk include consuming low-fatdairy products, adhering to the Mediterranean
diet, and avoiding sugar-sweetened beverages (13,18)
• The authors of a systematic review and meta-analysis of 60 studies reported a significant inverse correlation between intake
of low-fatdairy products and risk for developing DM2 (18)
• The authors of a systematic review and meta-analysis of 9 studies including more than 100,000 subjects found that those
with the highest adherence to the Mediterranean diet—which entails frequent consumption of a variety of fruits, vegetables,
grains, and fish; consuming heart-healthy fats, including olive oil; and consuming limited amounts of dairy products and
red meat—were 19% less likely to develop DM2 than those with the lowest adherence (13)
• The authors of a nationwide cohort study reported that light intake of alcohol was associated with a decreased risk of DM2
when compared with no consumption and heavy alcohol consumption (10)
• The authors of a systematic review and meta-analysis of 60 studies reported that consumption of sugar-sweetened
beverages was associated with an increased risk of DM2. Conversely, coffee consumption was associated with a 35%
reduced risk of DM2 (18)
–Replacing sugar-sweetened drinks with artificially-sweeteneddrinks has not been shown to lower the risk of DM2 and
may actually increase the risk (18)
› Group-based lifestyle intervention programmes (LIPs) involving DM2 prevention might promote long term behavior change
through methods that include participant relatedness and emotional support of peers (3)
› A number of pharmacologic agents have been studied to determine their efficacy in reducing the risk for new-onset
DM2(2,15)
• Researchers have demonstrated that several oral antidiabetic drugs are effective in reducing DM2 risk(2,15)
–In patients with prediabetes, metformin reduces the risk of developing DM2 by 31% at three years(14)
–In patients with prediabetes, pioglitazone reduced the risk for developing diabetes by 85% in patients over 61 years old
and 69% in patients under 61 years old at two years(7)
–The α-glucosidase inhibitor acarbose reduces DM2 risk by 20%(14)
• The ADA does not recommend the routine use of pharmacologic agents as a substitute for lifestyle changes, but suggests
that metformin therapy can be considered in patients with prediabetes, particularly in those with BMI > 35 kg/m2, age < 60,
and women with prior gestational diabetes(2)
› Bariatric surgery is associated with complete remission of DM2 in 58-72% of cases 2 years after surgery in patients with
obesity (11)
What We Can Do
› Learn about prevention interventions for DM2 so you can accurately assess your patients’ personal characteristics and health
education needs; share this information with your colleagues
› Review the ADA recommendations for information on evidence-based diet and exercise strategies available at
http://www.diabetes.org/are-you-at-risk/
› Increase awareness of the role culture plays in disease development and patient adherence to medical advice/
recommendations to promote the provision of patient education that is both relevant and culturally sensitive (8)
› Be cognizant of variations in perceptions of self-care behavior by nurses and patients (i.e., nurses’ perception of the need for
more health education for patients compared to patients’ beliefs that they are successfully managing their health needs) and
the impact of this on patient attitudes and motivation regarding patient education (17)
› Because risk factors for DM2 commonly develop before adulthood; educate parents on strategies and actions to reduce the
development of risk factors in their children (e.g., breastfeeding infants, encouraging an active lifestyle, healthy dietary
choices)
› Discuss the availability of local service providers with the diabetes nurse specialist and/or the medical social worker so
you can coordinate your patients’ use of a range of services, including community programs, health department resources,
specialty outpatient clinics, hospital specialty departments, screening services, and knowledgeable clinicians in primary care
and specialty private practices
• Local services can include walking groups, cooking demonstrations, nutritional classes, and media campaigns
› Educate all community clinicians—whether or not they provide direct DM2 services—regarding risk, screening, prevention,
and treatment for DM2 and the coordination of local DM2 resources
› Encourage your patients to ask their primary clinician for screening and/or a referral to a diabetes specialist service provider
if they suspect they are at high risk for DM2(15)
› Advocate for patient participation in decision-making related to DM2 treatment regimens that require lifestyle changes
› Encourage and model behavior changes that promote a healthy lifestyle
Coding Matrix
References are rated using the following codes, listed in order of strength:
M Published meta-analysis
RV Published review of the literature
SR Published systematic or integrative literature review
RU Published research utilization report
X Practice exemplars, stories, opinions
RCT Published research (randomized controlled trial)
QI Published quality improvement report
GI General or background information/texts/reports
L Legislation
R Published research (not randomized controlled trial)
PP Policies, procedures, protocols
C Case histories, case studies
PGR Published government report
U Unpublished research, reviews, poster presentations or
other such materials
G Published guidelines
PFR Published funded report
CP Conference proceedings, abstracts, presentation
References
1. American Diabetes Association. (2019). 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2019. Diabetes Care, 42(Suppl 1), S13-S28.
doi:10.2337/dc-18-S002 (RV)
2. American Diabetes Association. (2019). 3. Prevention or delay of type 2 diabetes: Standards of medical care in diabetes-2019. Diabetes Care, 42(Suppl 1), S51-54.
doi:10.2337/dc19-S003 (G)
3. Begum, S., Povey, R., Ellis, N., & Gidlow, C. (2020). A systematic review of recruitment strategies and behaviour change techniques in group-based diabetes prevention
programmes focusing on uptake and retention. Diabetes Res Clin Pract, 166, 1-13. doi:10.1016/j.diabres.2020.108273 (SR)
4. Bian, R. R., Piatt, G. A., Sen, A., Plegue, M. A., De Michele, M. L., Hafez, D., ... Richardson, C. R. (2017). The effect of technology-medicated diabetes prevention interventions
on weight: A meta-analysis. Journal of Medical Internet Research, 19(3), 1. doi:10.2196/jmir.4709 (M)
5. Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report, 2020: Estimates of diabetes and its burden in the United States. Retrieved January 27,
2021, from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf (PFR)
6. Degefa, G., Wubshet, K., Tesfaye, S., & Hirigo, A.T. (2020). Predictors of adherence toward specific domains of diabetic self-care among type-2 diabetes patients. Clin Med
Insights Endocrinol Diabetes, 13, 1-12. doi:10.1177/1179551420981909 (R)
7. Espinoza, S. E., Wang, C. P., Tripathy, D., Clement, S. C., Schwenke, D. C., Banerji, M. A., ... Musi, N. (2016). Pioglitazone is equally effective for diabetes prevention in older
versus younger adults with impaired glucose tolerance. Age, 38(5-6), 485-493. doi:10.1007/s11357-016-9946-6 (RCT)
8. Gonzalez, M.B., Herman, K.A., & Walls, M.L. (2020). Culture, social support, and diabetes empowerment among American Indian adults living with type 2 diabetes. Diabetes
Spectrum, 33(2), 156-164. doi:10.2337/ds19-0036 (R)
9. Greiner, B., Mercer, H., Raymond, C., Sonstein, L., & Hartwell, M. (2020). A recommendation for earlier screening of type 2 diabetes mellitus within the US population: A
cross-sectional analysis of NHIS data. Diabetes Res Clin Pract, 168, 104. doi:10.1016/j.diabres.2020.108376 (RU)
10. Lai, Y., Hu, H., Lee, Y., Ko, M., Ku, P., Yen, Y., & Chu, D. (2018). Frequency of alcohol consumption and risk of type 2 diabetes mellitus: A nationwide cohort study. Clin Nutr,
38, 1368-1372. doi:10.1016/j.clnu.2018.06.930 (C)
11. Magkos, F., Hjorth, M.F., & Astrup, A. (2020). Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat. Rev. Endocrinol, 16, 545-555.
doi:10.1038/s41574-020-0381-5 (RV)
12. Malkani, S., & Ayyoub, S. (2021). Diabetes mellitus, type 2. F.J. Domino (Ed.), The 5-minute clinical consult 2021 (29th ed.). Philadelphia, PA: Wolters Kluwer. (GI)
13. Matin-Pelaez, S., Fito, M., & Castaner, O. (2020). Mediterranean diet effects on type 2 diabetes prevention, disease progression, and related mechanisms. A review. Nutrients,
12(8), 1-15. doi:10.3390/nu12082236 (RV)
14. Moelands, S. V. L., Lucassen, P. L. B. J., Akkermans, R. P., De Grauw, W. J. C., & Van de Laar, F. A. (2018). Alpha-glucosidase inhibitors for prevention or delay of
type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus. Retrieved January 14, 2019, from http;//
cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005061.pub3/full (SR)
15. National Institute for Health and Care Excellence. (2017). Type 2 diabetes: Prevention in people at high risk. Retrieved January 14, 2019, from http://www.nice.org.uk/guidance/
PH38 (G)
16. National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes prevention program (DPP). Retrieved January 14, 2019, from
https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp (PFR)
17. O'Brien, C., van Rooyen, D., & Ricks, E. (2020). Self-management of persons living with diabetes mellitus type 2: Experiences of diabetes nurse educators. Health SA
Gesondheid: Journal of Interdisciplinary Health Sciences, 25, 1-11. doi:10.4102/hsag.v25i0.1381 (R)
18. Toi, P.L., Anothaisintawee, T., Chaikledkaew, U., Briones, J.R., Reutrakul, S., & Thakkinstian, A. (2020). Preventive role of diet interventions and dietary factors in type 2
diabetes mellitus: An umbrella review. Nutrients, 12(9), 1-17. doi:10.3390/nu12092722 (SR)
19. United States Preventive Services Task Force. (2021). Screening for abnormal blood glucose and type 2 diabetes mellitus: Draft recommendation statement. Retrieved March
16, 2021, from https://www.uspreventiveservicestaskforce.org (G)
20. Van Rhoon, L., Byrne, M., Morrissey, E., Murphy, J., & McSharry, J. (2020). A systematic review of the behaviour change techniques and digital features in technology- driven
type 2 diabetes prevention interventions. Digit. Health, 6, 1-27. doi:10.1177/2055207620914427 (SR)
21. World Health Organization. (2016). Global report on diabetes. World Health Organization. Retrieved January 14, 2019, from http://apps.who.int/iris/bitstream/
handle/10665/204871/9789241565257_eng.pdf.jsessionid=35A6696E65E5D56A06572C60A3F61DDE0?sequence=1 (PFR)
Template for Asking PICOT Questions
INTERVENTION
In ____________________(P), how does ____________________ (I) compared to
____________________(C) affect _____________________(O) within ___________(T)?
THERAPY
In __________________(P), what is the effect of __________________(I) compared to
_____________ (C) on ________________(O within _____________(T)?
PROGNOSIS/PREDICTION
In ______________ (P), how does ___________________ (I) compared to _____________(C)
influence __________________ (O) over _______________ (T)?
DIAGNOSIS OR DIAGNOSTIC TEST
In ___________________(P) are/is ____________________(I) compared with
_______________________(C) more accurate in diagnosing _________________(O)?
ETIOLOGY
Are____________________ (P), who have ____________________ (I) compared with those
without ____________________(C) at ____________ risk for/of
____________________(O) over ________________(T)?
MEANING
How do _______________________ (P) with _______________________ (I) perceive
_______________________ (O) during ________________(T)?
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
Short Definitions of Different Types of Questions
Intervention/Therapy: Questions addressing the treatment of an illness or disability.
Etiology: Questions addressing the causes or origins of disease (i.e., factors that produce or
predispose toward a certain disease or disorder).
Diagnosis: Questions addressing the act or process of identifying or determining the nature and
cause of a disease or injury through evaluation.
Prognosis/Prediction: Questions addressing the prediction of the course of a disease.
Meaning: Questions addressing how one experiences a phenomenon.
Sample Questions:
Intervention: In African-‐American female adolescents with hepatitis B (P), how does
acetaminophen (I) compared to ibuprofen (C) affect liver function (O)?
Therapy: In children with spastic cerebral palsy (P), what is the effect of splinting and casting(I)
compared to constraint-‐ induced therapy (C) on two-‐handed skill development (O)?
Prognosis/Prediction:
1) For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to
not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season
(T)?
2) In patients who have experienced an acute myocardial infarction (P), how does being a
smoker (I) compared to a non-‐smoker (C) influence death and infarction rates (O) during the
first 5 years after the myocardial infarction (T)?
Diagnosis: In middle-‐aged males with suspected myocardial infarction (P), are serial 12-‐lead
ECGs (I) compared to one initial 12-‐lead ECG (C) more accurate in diagnosing an acute
myocardial infarction (O)?
Etiology: Are 30-‐ to 50-‐year-‐old women (P) who have high blood pressure (I) compared with
those without high blood pressure (C) at increased risk for an acute myocardial infarction (O)
during the first year after hysterectomy (T)?
Meaning: How do young males (P) with a diagnosis of below the waist paralysis (I) perceive
their interactions with their romantic significant others (O) during the first year after their
diagnosis (T)?
Adapted from the PICOT Questions Template; Ellen Fineout-Overholt, 2006. This form may be used for educational & research purposes without permission.
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Title Page
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