Introduction

Experts claim an increase in the number of people with type 2 diabetes due to increasing population, obesity prevalence, ageing and physical inactivity. Previous research, as well as existing data, reveals a possible gap in diabetes management, whereby current interventions are not efficient enough to achieve their expected health outcomes. The purpose of this research criticism is to identify the position of the selected studies on the effects of refining patient education on healthy lifestyle practices on improving diabetes management efforts and promoting the health outcomes of diabetes patients. The PICOT question for this critique is: ‘In patients with diabetes mellitus, can a six months diabetes self-management education program delivered from a patient interface to an internet-enabled app enhance patient’s self-care knowledge and behaviors and quality of life as compared to conventional care?’

Background of Studies

Ostling et al. (2017), in their report, attempted to determine the frequency and foundations of 30-day readmission rates for diabetic patients, either as the leading cause of index admission or as a subordinate diagnosis equated to those without DM. Their question is grounded on studies claiming that patients who rely on traditional diabetic management methods tended to experience deterioration in their health due to lack of proper self-management awareness. Similarly, Coppola et al. (2016) purposed to clarify the perfect features of an inclusive patient edification program in medical works by answering open questions on frequency, topics and the number of educational sessions and barriers to self-management in their research. Studies have helped nurses discover that the rate of readmission among patients with type 2 diabetes can be significantly reduced by encouraging patients to adjust their lifestyles and to follow routine controls.

Equally, Ikramuddin et al. (2018), Cummings et al. (2016) aimed at comparing the stability of the Roux-en-Y gastric bypass (RYGB) used in scrupulous lifestyle and therapeutic care to achieve diabetes control targets. The studies compared RYGB’s five-year results with lifestyle and therapeutic intervention in overweight adults with type 2 diabetes. The results of the research are critical because they help nurses make evidence-based decisions while determining the most effective therapy for their respective patients. The studies have made a significant contribution to the nursing profession by encouraging patients to improve their lifestyle as a viable strategy for the administration of type 2 diabetes.

Relationship between Articles and the PICOT Question

The PICOT question was coded to evaluate the efficacy of therapeutic patient empowerment with a focus on healthy lifestyle activities compared to standard diabetes management strategies that affect patients ‘ health outcomes within six months. In this regard, the answer to this question required a selection of research articles that elaborately responded to this question. Cummings et al. ( 2016) addressed this issue by stating that intensive lifestyle intervention involving a healthier diet and being more physically active reduced readmission rates and improved overall patient quality of life. Likewise, Ikramuddin et al. (2018) revealed that educating patients on healthy lifestyles is effective in reducing complications associated with diabetes, which often lead to inpatient readmissions.

Equally, Ostling et al. (2017) used actual data and attached a timeframe on the research, thus making it similar to the PICOT question to some degree. The findings from the study confirm the hypothesis of the PICOT question as it is statically evident that adjustment in patient lifestyle assists in mitigating type 2 diabetes readmissions. Consistently, Coppola et al. (2016) strongly advocate for patient empowerment, changes in lifestyle, and adherence to stringent healthcare routine to mitigate type 2 diabetes.  Therefore, both studies are positively comparable to the PICOT question as they strive to validate the efficacy of lifestyle mediations and patient empowerment in dealing with type 2 diabetes.

Method of Study

Ostling et al. (2017), and Coppola et al. (2016) utilized the meta-analysis and systematic review research methodology. A systematic review is a primary research methodology that systematically isolates, selects, examines, and synthesizes research material relevant to the research question (European Stroke Organisation, 2018). Systematic review and meta-analysis enable researchers to offer credible conclusions that can be used in clinical practice as it facilitates the assessment of available evidence. The evaluation assists in the comprehension of reasons studies diverge in their findings and formulating an estimate of the projected consequence of an intrusion or exposure.

Systematic review and meta-analysis enable researchers to formulate credible conclusions that can be used in clinical practice through the assessment of available evidence. The evaluation assists in the comprehension of reasons studies diverge in their findings and formulating an estimate of the projected consequence of an intrusion or exposure (European Stroke Organisation, 2018). Therefore, reading adequately piloted systematic review is an adequate method to become accustomed to the best accessible research proof for an absorbed clinical problem. While these research methods are effective, it is essential to appreciate their potential flaws. First, the description of the literature presented in a structured review and meta-analysis is as accurate as the approaches used to guesstimate the impact of each research (European Stroke Organisation, 2018). As a result of discriminatory publishing, the method does not address partialities

On the other hand, Ikramuddin et al. (2018), and Cummings et al. (2016) utilized an experimental research methodology. The research method depends on the manipulation of a research variable and applied to one or more dependent variables to measure their effect on the latter. The researchers usually observe and record the impact of the independent variables on dependent variables over some time, to assist them in the formulation of rational conclusions regarding the relationship between these two variable types. The research method was appropriate for these studies because it gives the researcher significant amounts of control. The researchers could isolate specific variables to ensure the desired outcomes could be achieved. The researchers controlled each variable independently or in different combinations to study what possible results are available for the hypothesis. However, the methodology is vulnerable to human error due to its dependency on variable control that may be implemented improperly. These inaccuracies could disregard the cogency of the experiment and the research being conducted.

Results of the Study

Ikramuddin et al. (2018) found that members of the gastric bypass cluster experienced an average weight loss of 22.9% to 6.3% in the lifestyle medical community after five years. With the lifestyle-medical administration group, there was no remission of diabetes at any time, apart from two members who preferred gastric operation in the third year. The study showed that RYGB had severe adverse effects than conventional lifestyle treatment, most commonly gastrointestinal and surgical problems such as stretching, mild intestinal difficulties, and leakages. The gastric bypass had an upsurge in parathyroid hormone, but there was no variance in the B1 deficit.

Cummings et al. (2016), observed a decline in systolic blood pressure in the surgical arm from baseline to one year but no discernable change in the ILMI section. Diastolic blood pressure in both groups was equivalent to zero and 12-months and did not significantly rise with both interventions. Average health scores in each group improved at baseline and 12 months, but there was no difference in the degree of improvement among groups. Therefore the study found that RYGB produced more type 2 diabetes reduction in trivial to ascetically overweight participants drafted from a conversant, population-based sample matched with the most comprehensive ILMI yet tested against surgery in a randomized pilot.

Coppola et al. (2016) found that TPE is typically affiliated with an enhancement in medical, knowledge, lifestyle, and psycho-social consequences when equated to conventional care. However, the study did not give a specific deduction due to the scarcity of data necessary to offer a definite answer to the research question, particularly on the real scale of TPE efficacy and effect on long-term aftermaths.

Ostling et al. (2017) split their study into three-month experimental research focusing on the primary DM examination and twelve-month DM secondary diagnosis research. The three-month pilot study recorded 7,763 admissions, 97% of which were released alive, and DM was diagnosed at 25%. Patients with any DM diagnosis had an overall readmission rate of 26.4% over 30 days compared to 22.6% for non-DM patients. Patients with either primary or tributary DM had an expressively high degree of readmission. The 12-month study with readmitted rates for patients with DM for 37,702 participants was 24.5% and 17.7% for those without DM. Readmission rates are due to infections, acute renal failure, transplantation complications, and complications associated with DM.

Ethical Considerations

Ethics are essential in research. Informed consent ensures the participant’s right to independence is preserved to ensure people participate in the study voluntarily after being informed of potential risks and benefits of the investigation. The ethical principle of beneficence details the Hippocratic of providing research is designed to serve the participants and promote the welfare of participants.

Cummings et al. (2016) approached participants through mail and phone before screening them utilizing a multi-level enrolment process. A study GP acquired in-person approval from participants and ensured concealed allocations. Ikramuddin et al. (2018) confirmed that all research sites had obtained official review board authorization and printed informed permission from all members.

Coppola et al. (2016), complying with all ethical requirements. No informed consent was necessary as no patient was recruited. The authors also declared no conflict of interest. In the retrospective quality enhancement study, Ostling et al. (2017) sought ethics approval and consent to participate, and they declared they did not have any competing interests.

Outcomes Comparison

The PICOT question was designed to tackle the gap presented by inadequate diabetes management interventions and programs. The objective was to review and determine the contributions of patient education on healthy lifestyle practices enhancing diabetes management efforts and promoting positive outcomes among patients. Similarly, the research articles shared a similar objective, and as such, their findings are positively aligned with the anticipated results of the PICOT question. The anticipated outcomes were validation that patient education, especially on lifestyle adjustments, contributes towards enhanced management and treatment of diabetes.

References

Coppola, A., Sasso, L., Bagnasco, A., Giustina, A., & Gazzaruso, C. (2016). The role of patient education in the prevention and management of type 2 diabetes: An overview. Endocrine, 53(1), 18-27.  DOI: 10.1007/s12020-015-0775-7.

Cummings, D. E., Arterburn, D. E., Westbrook, E. O., Kuzma, J. N., Stewart, S. D., Chan, C. P., … &Flum, D. R. (2016). Gastric bypass surgery vs. intensive lifestyle and medical intervention for type 2 diabetes: The CROSSROADS randomised controlled trial. Diabetologia, 59(5), 945-953. DOI: 10.1007/s00125-016-3903-x

Ikramuddin, S., Korner, J., Lee, W. J., Thomas, A. J., Connett, J. E., Bantle, J. P., … & Chong, K. (2018). Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobinA1c, LDL cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study. Jama, 319(3), 266-278. DOI: 10.1001/jama.2017.20813

Ostling, S., Wyckoff, J., Ciarkowski, S. L., Pai, C. W., Choe, H. M., Bahl, V., & Gianchandani, R. (2017). The relationship between diabetes mellitus and 30-day readmission rates. Clinical Diabetes and Endocrinology, 3(1), 3.