Research Critiques and Evidence-Based Practice Change Proposal – Type 2 Diabetes 

Research Critiques and Evidence-Based Practice Change Proposal – Type 2 Diabetes 

Type 2 diabetes is a chronic metabolic disorder characterized by sustained hyperglycemia. It is one of the leading causes of suffering across the globe and has been associated with high morbidity, mortality, and escalating costs of healthcare. The growing prevalence of the disease makes it a global health concern. The disease currently affects over 425 million people worldwide, and the number is expected to double by 2050.

Comprehensive management of diabetes has traditionally focused on disease prevention and aggressive blood sugar control using medications and lifestyle modification. Integral to lifestyle modification modalities is carbohydrate control. Dambha-Miller et al. (2023) note that carbohydrate restriction optimizes blood glucose control and should be applied to all diabetics and persons at risk of the disease. There is a consensual finding on the adjunctive use of diet and medication in controlling diabetes. It is, however, unclear whether carbohydrate-restricted diets are more effective in increasing the remission probability of diabetes compared to standard medical therapy. This paper synthesizes the literature on the effectiveness of carbohydrate restriction in increasing the probability of diabetes remission. The PICOT question utilized in the literature review is: In obese patients with type 2 diabetes (P), is compliance to a carb-controlled diet (I) more effective than standard medical therapy (C) at increasing the probability of remission of diabetes (O)?

Methods of Studies

The literature search for the articles relevant to the PICOT question yielded four articles. Qualitative and quantitative research methodologies are the primary study methods applied in the identified studies. Qualitative methods involve the collection and analysis of non-numerical data. Quantitative methodologies, on the other hand, utilize numerical data. The identified qualitative study was instrumental in explaining patient and caregiver experiences and perceptions of the use of carbohydrates. Findings from the study addressed the PICOT components of intervention, population, and outcomes. The study demonstrated that carbohydrate control is efficacious in controlling blood sugar, and persons with diabetes or those at risk of developing the disease, such as obese or overweight individuals, should consider making a carb-restricted diet as a measure of minimizing their risk of developing diabetes. Likewise, the study addressed the intervention and population aspects of the PICOT question. It revealed that a carb-restricted diet is effective in optimizing glycemic control

The quantitative studies were effective in demonstrating the efficacy of a carbohydrate-restricted diet in optimizing glycemic control. The study used the quantitative design to explore the feasibility of a carb-controlled diet. It answered the population, intervention, and outcome components of the PICOT question. Likewise, the study addressed the PICOT aspects of intervention and outcomes. The study noted reductions in HbA1c, weight, and medication requirements in persons who complied with low diet instructions. This affirmed the effectiveness of carbohydrate restrictions in controlling and increasing remission potential in persons with diabetes.

Result of Studies

The four studies demonstrated the significance of carb-controlled diets in optimizing blood sugar control. The first study utilized quantitative methods to gather insights into the efficacy of early restricted consumption of carbohydrates in people with type 2 diabetes. The study found that early time-restricted carbohydrate intake effectively optimized glycemic control. An analysis of the 14-day blood glucose averages showed that early time-restricted carbohydrates only produced two early postprandial glucose peaks translating to improved glucose control.  This affirmed the feasibility and effectiveness of carb-controlled diets, warranting their application in persons with diabetes.

The second article utilized quantitative methods to evaluate the effectiveness of adjunctive use of standard care for diabetes and a web-based health education program on carbohydrate-controlled diets in optimizing blood glucose control among adults with type 2 diabetes. The article found that low carbohydrate diets coupled with standard therapeutic modalities for diabetes were more effective in lowering the HbA1c levels, weight, and medication requirements. It is thus important that carb-restricted diets be integrated into the care plans for adults with type 2 diabetes to increase the chances of remission.

The third article utilized qualitative methods to interrogate the experiences and perceptions of obese individuals or diabetics on eating behaviors and appetite. The study found that persons with diabetes and obesity recognize the significance of food and make healthy food choices in managing diabetes and lowering the risk of developing the disease. Making food choices based on the carbohydrate content allowed them to take low-carbohydrate diets. It is thus important that patients with diabetes and those at risk of developing the disease are educated on the importance of carbohydrate restriction as a measure for enhancing diabetes control (Poon et al., 2024).

The fourth study utilized qualitative technique to explore dietitians experience prescribing diabetes nutrition therapy. The study found that carbohydrate-controlled diets were effective in optimizing glycemic control. The author advocated for increased education on diabetes nutrition, emphasizing the need to scale down carbohydrate intake to improve the care outcomes of patients with diabetes and those at risk of developing the disease (Viljoen et al., 2024).

Outcome Comparison

The anticipated outcome for the PICOT question is an increased probability of remission of diabetes. There is a consensus finding on the need to optimize glycemic control and subsequently increase the probability of disease remission. The articles explored effective dieting to restrict carbohydrate intake and its impact on glycemic control. The first article by showed that carb control optimized glycemic control. The highlighted outcome from the article is nearly similar to the anticipated outcome. It, however, differs slightly from the anticipated outcome as it does not detail disease remission.

The second study revealed that a carb-controlled diet resulted in reductions in HbA1c levels, weight, and medication use among diabetics. This outcome is similar to the anticipated one, as diabetes remission is demonstrated by healthy weight, reduced HbA1c levels, and decreased need for anti-diabetic medications (Tricò et al., 2023).

The outcome of the third article is also aligned with the anticipated outcomes of the PICOT question. The study found that obese and overweight individuals and diabetics recognize the significance of carb-controlled diets and reinforced the need to tailor patient education toward reducing carbohydrate intake (Poon et al., 2024). The outcome, however, differs from the anticipated outcomes as it does not capture the overall health impact of controlling carbohydrate intake and carb-controlled diet education on diabetes remission. The study, in this respect, does not address the outcome components of the PICOT questions but rather the intervention and population aspects.

The fourth article also details the significance of controlling carbohydrate intake. It revealed that dietitians prefer prescribing carbohydrates restricted due to their effectiveness in optimizing blood sugar control. The outcomes of the study are similar to the anticipated outcomes as it demonstrates the role of diet in controlling blood sugar. However, the outcomes are unclear on the impact of carbohydrate control in increasing the potential for diabetes remission (Viljoen et al., 2024).

Proposed Evidence-Based Practice Change

The PICOT questions designed for the study guided the interrogation of the effectiveness of carbohydrate restriction in increasing remission potential in diabetes. There is a nexus between the PICOT question, the identified articles, and the use of carbohydrate control diets in managing diabetes. The highlighted studies answered several aspects of the PICOT questions. There is a consensus across the four articles on the role of carbohydrate control in optimizing blood sugar control. The studies by Tricò et al. (2023) and Unwin et al. (2023) demonstrated carbohydrate control, used alone or in combination with standard therapies, improved disease indicators such as HbA1c levels, weight, and blood sugar control. This effectively answers the intervention and outcome areas on the PICOT question. Findings from the study also give insight into quality improvement in diabetic care. They can be used to affirm the use of carbohydrate control as an intervention to optimize blood sugar control.

Findings from the article give insight into non-pharmacological interventions in the comprehensive management of diabetes. An evidence-based practice that can be elucidated from the articles is the use of carbohydrate-restrictive diets in the comprehensive management of diabetes, as well as in lowering disease risk, especially in at-risk populations. Integrating diet-related education emphasizing the significance of limiting carbohydrate intake should thus be encouraged as a preventive approach against diabetes. Likewise, carbohydrate control can be integrated into therapeutic care plans for patients with diabetes to optimize their blood glucose control and subsequently increase the probability of remission.

The anticipated outcomes can be assessed through periodic evaluation of the HbA1c levels. HbA1c level measurements provide a sure way of ascertaining the level of glycemic control. Periodic evaluation of the HbA1c levels after implementing the proposed intervention can help elucidate whether the intervention was effective.

Comprehensive management of diabetes integrates pharmacological and non-pharmacological intervention. Carbohydrate restriction is one of the mainstay non-pharmacological approaches that is effective in optimizing blood sugar control. Findings from the articles affirmed the position of carb restriction in managing diabetes and lowering the risk of developing the disease among at-risk populations. They addressed the aspects of population, intervention, and outcome components of the PICOT question. In the resolve to elevate the quality of diabetic care and the health and clinical outcomes of diabetics, integrating the proposed intervention into the care plan for patients with diabetes should be considered. The proposed study, in this respect, contributes to the body of knowledge of diabetic care by comparing carb-control and standard therapies.

References

Dambha-Miller, H., Hounkpatin, H. O., Stuart, B., Farmer, A., & Griffin, S. (2023). Type 2 diabetes remission trajectories and variation in risk of diabetes complications: A population-based cohort study. PLOS ONE, 18(8). https://doi.org/10.1371/journal.pone.0290791

Poon, J. L., OHara, L., Kendal, H., Sully, K., Guy, M., Bradley, H., Tolley, C., & Mason, B. (2024). Perceptions and experiences of people with obesity and type 2 diabetes around appetite and eating behaviors: A qualitative study. Advances in Therapy, 41(5), 2028–2049. https://doi.org/10.1007/s12325-024-02846-5

Tricò, D., Masoni, M. C., Baldi, S., Cimbalo, N., Sacchetta, L., Scozzaro, M. T., Nesti, G., Mengozzi, A., Nesti, L., Chiriacò, M., & Natali, A. (2023). Early time-restricted carbohydrate consumption vs conventional dieting in type 2 diabetes: A randomised controlled trial. Diabetologia, 67(2), 263–274. https://doi.org/10.1007/s00125-023-06045-9

Unwin, D., Delon, C., Unwin, J., Tobin, S., & Taylor, R. (2023). What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutrition Prevention & Health, 6(1), 46–55. https://doi.org/10.1136/bmjnph-2022-000544

Viljoen, A., Yu, K., Witchell, E., & Conklin, A. I. (2023). Prescribing diabetes nutrition therapy: A qualitative study of dietitians’ experiences of carbohydrate restriction in Canada. BMJ Nutrition, Prevention & Health, 6(1), 83–90. https://doi.org/10.1136/bmjnph-2022-000532

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Assessment Description
The purpose of this assignment is to synthesize a literature review that will be used to draw conclusions in order to propose an evidence-based practice change to address your identified nurse practice problem.

Research Critiques and Evidence-Based Practice Change Proposal – Type 2 Diabetes

Using the “Literature Evaluation Table” assignment in Topic 1, and accompanying faculty feedback, you will synthesize the information created for your PICOT question into a literature review and evidence-based proposal.

In a 1,500-1,750-word paper, provide an overview that illustrates the research related to your particular PICOT question.

Use the following components from the “Literature Evaluation Table” to complete the assignment:

Identified practice problem
Two qualitative peer-reviewed research articles
Two quantitative peer-reviewed research articles
Use the “Research Critiques and Evidence-Based Practice Proposal Guidelines” document to organize your paper.

You are required to cite a minimum of four peer-reviewed sources to complete this assignment. Sources must be published within the past 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.