Background

Discusss about the Factors involved in causing type 2 diabetes.

Conduction of literature review is a significant part of the research process which helps to identify the components of the area of interest. Conducting a literature review helps to identify the gaps in the research. There are several types of literature reviews, like primary, secondary and tertiary literature reviews.

The paper aims to understand the disease diabetes through the studies carried out in the various papers.

For the purpose of carrying out the studies, various databases were searched like the Pubmed, Medline, JSTOR and Google Scholar. The key words searched were diabetes, type 2 diabetes, HbA1c, diabetes causing factors. The papers that were searched using these databases were published between the years 2012 and 2018.

This study helps to recognise the factors that are involved in the particular disease management which were identified as being lifestyle management, adherences to medicine and increasing the glycaemic controls. Additionally the use of the Patient Engagement and Coaching for Health (PEACH) program through a controlled and randomised study has been discussed which helps to promote care to the patients affected with the concerned disease.

The study suggests several drugs that has components which are beneficial for managing the disease of concern. Some of the types of agents are included are Metformin which helps to decrease the resistance to insulin. It also reduces the hepatic glucose output and enhances the peripheral glucose utilisation.

Conclusion

To investigate the nursing practise of patient engagement with the procedure of coaching for health, randomised and controlled trials are conducted with a pragmatic cluster.

Key terms: Diabetes, type 2 diabetes, HbA1c, diabetes causing factors, PEACH program

Introduction

Conduction of literature review is a significant part of the research process which helps to identify the components of the area of interest. Conducting a literature review helps to identify the gaps in the research. There are several types of literature reviews, like primary, secondary and tertiary literature reviews. In case of primary, the sources that are used refer to the original sources which are based on the observations that are perceive directly by the researcher. It can be any peer- reviewed journal or a published articles and reports. The secondary literature reviews involves the data that is obtained from sources of interpretations and evaluations that are conducted based on the primary sources of the literature. Finally in case of tertiary, the sources are mainly the textbooks or articles of encyclopaedia and guidebooks which represent a collection of the primary and the secondary literature sources.

Aim

Aim and objectives

The paper aims to understand the disease diabetes through the studies carried out in the various papers.

Methods

For the purpose of carrying out the studies, different databases were searched like the Pubmed, Medline, JSTOR and Google Scholar. The key words that earched were diabetes, type 2 diabetes, HbA1c, diabetes causing factors. The papers that were searched for were published between the years 2012 and 2018.

Results

Author/ Date	Journal	Title	Methodology
Blackberry 2013	theBMJ	Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial	A cluster randomised controlled trial is employed, with general practices as the unit of randomisation.
Courcoulas et al., 2014	JAMA Surgery	Surgical vs Medical Treatments for Type 2 Diabetes Mellitus- A Randomized Clinical Trial	Qualitative study design through telephonic conversations. A study is a randomised clinical trial.
Balkau 2012	Diabetes & metabolism	Type 2 diabetes treatment intensification in general practice in France in 2008–2009: the DIAttitude Study	Type 2 diabetic patient characteristics along with calloection of HbA1c values, hypoglycaemic treatment and physician characteristics from the electronic records of a panel of French general practitioners. Factors associated were studied with the Cox model.

The type 2 diabetes is a complex health condition, which is responsible for imposing a financial and health burden on the individuals. It had been suggested in studies that lifestyle modification and adherence to proper medications can help in management of the disease (Nauck, 2014). Medications must be administered with aim of reducing the blood glucose level along with the reduction of risk of cardiovascular diseases. However it has been reported in studies that about half the population of patient suffering form type 2 diabetes, have been seen to obtain a glycaemical target of HbA1c that is about less that 7 %. Additionally there have been reports that two-thirds of this population often die from incidents of premature cardiovascular disease. Studies reveal that insufficient adherence to anti-diabetes agents of oral nature represents < 80% of prescribed medication that is collected and it is estimated that 36% and 93% of patients are applied with this (Ley et al., 2014). Most of the studies carried out in this field confirms that an effective proportion of type 2 diabetes patients often shows reduced adherence to medications which eventually lead to the contribution that is less than the desired control.

Findings

The study is involved in the illustration of the several evidence based practises can that be implemented in order to improve the conditions of management in case of type 2 diabetes. This study helps to identify the factors that are involved in management of the disease which were recognised as being lifestyle management, adherences to medicine and increasing the glycaemic controls. Additionally the use of the Patient Engagement and Coaching for Health (PEACH) program through a controlled and randomised study has been discussed which helps to promote care to the patients affected with the concerned disease. The study also highlights the importance of recognition of the HbA_1c measures, which identifies the therapeutic recommendations for the patient population (Balkau et al., 2012). The study also puts forwards the importance of glycaemic control which includes the micro-vascular complications of diabetes like retinopathy along with neuropathy and nephropathy (Courcoulas et al., 2015). These complications are closely associated with the glucose and HbA1c values. The study also states the importance of health personnel in terms of improving the communications, cost addressing and improvement of the events that can have a potential adverse effect. 

Methods

Relevance to clinical practise

The study suggests several drugs that has components which are beneficial for managing the disease of concern. Some of the types of agents are included are Metformin which helps to decrease the resistance to insulin. It also reduces the hepatic glucose output and enhances the peripheral glucose utilisation. This results in approximately 1-2 % of HBA_1ac  decrease. Other such drugs includes Sulfonylureas, Meglitinide and Thiazolidinediones, a-glucosidase inhibitors, Bromocriptine and Colesevelam. These reduce HBA_1ac to 1-2%, 0.5-1.5 and 0.5-1.5%, 1-2%, 0.5%-0.8%, 0.5%-0.8% and 0.5-2.0% respectively (Inzucchi et al., 2015). The barriers of the adherence process includes the patient factors like fear, skill and knowledge, self-reliance, depression, beliefs related to health, Lack of confidence in benefits of medication that might be in future or immediate action and the remembrance of the doses. The respective regimen factors associated with the patient factors includes complexity of regimen, dose frequency, cost, adverse events and the lifestyle interference. The study also describes the t hypoglycaemic treatment intensification that have been followed for a period of 14 years. The data shows that the Patients with at least two HbA1c values are a total of 17493 patients, Patients requiring treatment intensification are 3118 (18%) of patient population. Finally patients with treatment intensification after the second HbA1c above the threshold values are 1212 (39%) of the affected population. the randomised and the controlled trails that were conducted showed that the patients in the intervention and control groups were almost same at baseline. The results suggested that the PEACH program there were comparable outcomes to usual primary care in diabetes (Blackberry et al., 2013). It was seen that the generalist role of a practice nurse without prescribing rights was ineffective.

Conclusion

From the above discussion it can be concluded that type 2 diabetes represents a chronic condition, the intensity of which varies with the treatment programs and the complexity of the disease. The studies evidently represents that there is a significance relation between the medication adherence and the other prevalent therapies. The factors that prove to be barriers in the path of adherence are required to be identified and addressed for providing proper management of disease. The paper also illustrates the significance of the role that is played by the medical personnel in addressing the problems of adherence and suggests methods in order to improve the conditions of management of the concerned disease.  The paper also successfully highlighted a randomised study using pragmatic cluster which showed that existing generalist practice nurses without prescribing rights was effective in comparison with that of the usual primary care for type 2 diabetes.

References

Ajala, O., English, P., & Pinkney, J. (2013). Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes–. The American journal of clinical nutrition, 97(3), 505-516. Retrieved from: https://academic.oup.com/ajcn/article/97/3/505/4571510

Bailey, C. J., & Kodack, M. (2011). Patient adherence to medication requirements for therapy of type 2 diabetes. International journal of clinical practice, 65(3), 314-322. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1742-1241.2010.02544.x

Balkau, B., Bouee, S., Avignon, A., Verges, B., Chartier, I., Amelineau, E., & Halimi, S. (2012). Type 2 diabetes treatment intensification in general practice in France in 2008–2009: the DIAttitude Study. Diabetes & metabolism, 38, S29-S35. Retrieved from: https://www.sciencedirect.com/science/article/pii/S126236361271532X

Blackberry, I. D., Furler, J. S., Best, J. D., Chondros, P., Vale, M., Walker, C., … & Liew, D. (2013). Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement and Coaching for Health (PEACH) pragmatic cluster randomised controlled trial. Bmj, 347, f5272. Retrieved from: https://www.bmj.com/content/347/bmj.f5272.full

Courcoulas, A. P., Belle, S. H., Neiberg, R. H., Pierson, S. K., Eagleton, J. K., Kalarchian, M. A., … & Jakicic, J. M. (2015). Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA surgery, 150(10), 931-940. Retrieved from: https://jamanetwork.com/journals/jamasurgery/fullarticle/2362353

Courcoulas, A. P., Goodpaster, B. H., Eagleton, J. K., Belle, S. H., Kalarchian, M. A., Lang, W., … & Jakicic, J. M. (2014). Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial. JAMA surgery, 149(7), 707-715. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/jebm.12042

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-149. Retrieved from:https://care.diabetesjournals.org/content/38/1/140?ref=driverlayer.com/web&patientinform-links=yes&legid=diacare;38/1/140

Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), 1999-2007. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0140673614606139

Nauck, M. A. (2014). Update on developments with SGLT2 inhibitors in the management of type 2 diabetes. Drug design, development and therapy, 8, 1335. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166348/

Pal, K. (2013). Computer?based diabetes self?management interventions for adults with type 2 diabetes mellitus. Journal of evidence-based medicine, 6(2), 119-120. Retrieved from: