Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx

Running Head: LITERATURE REVIEW
1
LITERATURE REVIEW
5
Literature Review
Name: Liliana Faura
Course: NRS-490
Professor: Tish Dorman
Date: 1/12/2020
Introduction
The continued prevalence of type II diabetes has been blame d
on sedentary lifestyle, but for a long time now, health experts
have suggested dietary and lifestyle changes to reverse the
trend, which may include but no limited to healthy eating and
regular exercise. Scholars and clinicians have been evaluating
the impact of the obesity on individuals and resources dedicated
to curb the problem as not confined only to health impacts such
as various types of diabetes and high-blood pressure, but also
economic-wise. To shed more light on the issue of type II
diabetes, this review compares the research questions, sample
population, and limitation of various research studies regarding
the topic of dietary and lifestyles changes for type 2 diabetic
patients.
Comparison of Research Questions
According to Czupryniak et al (2010), the underlying question
for the question is the impact of bariatric surgery on morbidly
obese type II patients. However, as compared to Brun et al
(2008), seek to answer the question of the targeted endurance
training as weight reduction as well as fitness strategy on type
II diabetic patients. Similarly, Umpierre (2011) seeks to

determine the difference between physical activity exercise and
structured exercise training on the regulation of glucose on type
two patients. While prior scholars have dealt with lifestyles
changes and surgery, Asemi et (2011) sought to answer the
question of the impacts of “multispecies probiotic supplements
on metabolic profiles, hs-CRP, and oxidative stress in diabetic
patients.” While surgery is not a common way of managing
weight for diabetic patients Picot et al (2012) echoes
Czupryniak et al (2010) in trying to answer the question of the
effectiveness of bariatric surgery as a way of managing weight
on diabetic patients. Evidently, both lifestyle and dietary
changes are some of the strategies used to manage
complications associated with type II diabetes but there are
other uncongenial ways such as bariatric surgery to manage
weight in diabetic patients.
Comparison of Sample Populations
Picot et al (2012) searched 17 electronic sources, which is an
according to the scholars, the meta-analysis was carried out
strictly on studies that met criteria of the subject matter.
Conversely Asemi et al (2013) randomly selected a sample size
of 54 diabetic patients for their research. While the two studies
use different reach methods, it is evident that quantitative
research is more reliable in terms of sample size that qualitative
research. Also, Brun and colleagues randomly selected 25
diabetic patients for their study, which pales only three (3)
patients selected by Czupryniak and colleagues. Comparatively,
Ninot et al (2011) randomly selected a total of 38 diabetic
patients for their study, but the difference between this study
and others is that, most of the selected patients were severely
sick and hospitalized. It can, therefore, be posited that the
study results differed with those with moderately-ill patients.
Conversely, Rubino et al (2016) selected a total of 48
international scholars and clinician on their study on the
effectiveness of bariatric surgery on type II diabetic patients,
which is departure from previous studies which focused majorly
on patients as population samples.

Comparison of the Limitations of the Study
The study by Rubino and colleagues was limited by the fact that
bariatric surgery is not yet included as one of the ways of
helping patients with type 2 diabetes. According to the
researchers, bariatric surgery could be effective in tackling
obesity but there are reimbursement policies to support the
same. Similarly, a study by Czupryniak and colleagues was
limited experience on bariatric surgery, which according to the
scholars has demonstrated unequivocal success in helping
diabetic patients. Li et al (2012) study was limited by undefined
difference in terms exercise duration and exercise duration.
Also, Picot and colleagues’ study was limited by the accuracy
of the electronic sources, which according to the scholars came
from inconsistent citations. Studies such as Brun’s and
colleagues were limited by the respondent bias, where in some
instances, patients gave inaccurate responses to the questions.
Conclusion
Diabetes is an epidemic that continues that continue to
overwhelm the health sector as well as ability to diagnose
different types of the disease. While research has been focused
on how to treat patients with diabetes, there are other
complications, such as obesity, that require different approaches
of treatment. Clinicians and scholars, however, recommend
dietary and lifestyle changes as prevention measure, but recent
development in the field of clinical medicine as focused
bariatric surgery as one of the approaches of treating obese
patients with type 2 diabetes. Hence, owing to the limited
experience in the area, there is a need to advance research to
explore the effectiveness of bariatric surgery on type II diabetic
patients.
References
Asemi, Z., Zare, Z., Shakeri, H., Sabihi, S., & Esmaillzadeh, A.
(2013). Effect of Multispecies Probiotic Supplements on
Metabolic Profiles, hs-CRP, and Oxidative Stress in Patients
with Type 2 Diabetes. Annals of Nutrition and Metabolism,

63(1-2), 1–9. doi:10.1159/000349922
Brun, J.-F., Bordenave, S., Mercier, J., Jaussent, A., Picot, M.-
C., & Préfaut, C. (2008). Cost-sparing effect of twice-weekly
targeted endurance training in type 2 diabetics: A one-year
controlled randomized trial. Diabetes & Metabolism, 34(3),
258–265. doi:10.1016/j.diabet.2008.01.010
Czupryniak, L., Wiszniewski, M., Szymański, D., Pawłowski,
M., Loba, J., & Strzelczyk, J. (2010). Long-Term Results of
Gastric Bypass Surgery in Morbidly Obese Type 1 Diabetes
Patients. Obesity Surgery, 20(4), 506–508. doi:10.1007/s11695-
010-0074-6
Li, J., Zhang, W., Guo, Q., Liu, X., Zhang, Q., Dong, R., …
Yu, D. (2012). Duration of Exercise as a Key Determinant of
Improvement in Insulin Sensitivity in Type 2 Diabetes Patients.
The Tohoku Journal of Experimental Medicine, 227(4), 289–
296. doi:10.1620/tjem.227.289
Ninot, G., Moullec, G., Picot, M. C., Jaussent, A., Hayot, M.,
Desplan, M., … Prefaut, C. (2011). Cost-saving effect of
supervised exercise associated to COPD self-management
education program. Respiratory Medicine, 105(3), 377–
385. doi:10.1016/j.rmed.2010.10.002
Picot, J., Jones, J., Colquitt, J. L., Loveman, E., & Clegg, A. J.
(2012). Weight Loss Surgery for Mild to Moderate Obesity: A
Systematic Review and Economic Evaluation. Obesity Surgery,
22(9), 1496–1506. doi:10.1007/s11695-012-0679-z
Rubino, F., Nathan, D. M., Eckel, R. H., Schauer, P. R., Alberti,
K. G. M. M., Zimmet, P. Z., … Cummings, D. E.
(2016). Metabolic Surgery in the Treatment Algorithm for Type
2 Diabetes: A Joint Statement by International Diabetes
Organizations. Surgery for Obesity and Related Diseases, 12(6),
1144–1162. doi:10.1016/j.soard.2016.05.018

Umpierre, D. (2011). Physical Activity Advice Only or
Structured Exercise Training and Association With
HbA1cLevels in Type 2 Diabetes. JAMA, 305(17),
1790. doi:10.1001/jama.2011.576
Running head: PICOT STATEMENT
1
PICOT STATEMENT
2
Picot Statement
Liliana Faura
GCU
Professional Capstone and Practicum
12/08/2019
PICOT Statement
P- Patients who have diabetes.
I - Implementation specifically on dietary and lifestyle changes.
C- Comparisons of levels before and after lifestyle and dietary
modifications.
O- Outcome whether there will be a reduction in levels.
T- The time frame is usually three months after initial diagnosis
PICOT Statement: Diabetic Condition in Patients.
Introduction
According to the World Health Organization, diabetes is one of
the most serious conditions that affect a significant percentage
of individuals in the worldwide population. It is estimated that

more than 400 million people in the world are likely to be
diagnosed with diabetes, while those that have not been
diagnosed totaling to the same number. Although diabetes can
be attributed to hereditary conditions during a person’s life,
what is more, devastating is the increase in cases of diabetes
type II, which is usually preventable, affecting more than 90%
of individuals with diabetic conditions in the world (Abbade et
al., 2017). This put a lot of questions on the effectiveness of the
current assessment techniques and procedures applied to control
the condition in the world. Diabetes II is usually attributed to a
high intake of processed foods that are mostly sugary.
Picot Statement
Population
Adults with early type II diabetes are more likely to be obese,
whereby most of them are usually women. The type II diabetes
is an epidemic especially in the US whereby it is estimated to
have increased by 70% in adults. Research has estimated that
close to 80% of individuals with diabetic conditions live in
middle and low-income countries (Abbade et al., 2017). China
had the highest number of individuals with diabetes, followed
by India with more than 10% of individuals with diabetic
conditions. Over the last three decades, there has been an
increase in cases of diabetes prevalence, which has been noted
at all ages, although the adults are more disadvantaged.
Intervention
Evidence-based intervention that seeks to reduce both childhood
and adulthood diabetic incidences should target the preventive
and treatment measures. Patient-level interventions usually
include those directed at improved self-management including
taking medication, proper diet and exercise and self- monitoring
in the use of health care services. Professional education and
knowledge activities are examples of strategies that can be put
in place to cope with the condition. Since interventions are

designed for the general population, the disadvantaged groups
may not be able to take full advantage of the opportunities
(Boswell & Cannon, 2018). In some cases, interventions may
include change of school curriculum for students whereby
physical education, change in meal provisions and physical
exercise is usually encouraged.
Comparison
Since the physician is a member of the multidisciplinary team,
then standardized care in support of good care is likely to be
provided to ensure there is a healthy community. The physician
plays a greater role in ensuring there is proper access to
medicare through provision checkup services and screening
services to help in the diagnosis of the disease (Boswell &
Cannon, 2018). Individuals should focus on ensuring there is a
healthy living and the need to expand the role of health care
providers.
Outcome
When a physician is involved as one of the members of the
multidisciplinary team approach, then there is guaranteed better
care for an individual. The outcomes from the intervention
should include a reduction in cases of diabetes and the risks
related to the disease with the provision of affordable healthcare
services.
Time
The treatment of diabetes, especially type II, should take
approximately three months. The reason being that the focus is
usually on general behavior patterns of individuals. Therefore,
interventions should aim at the promotion of long term
outcomes.
Reference
Abbade, L. P., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L.,

& Thabane, L. (2017). The framing of research questions using
the PICOT format in randomized controlled trials of venous
ulcer disease is suboptimal: A systematic survey. Wound Repair
and Regeneration, 25(5), 892-900.
Boswell, C., & Cannon, S. (2018). Introduction to nursing
research. Jones & Bartlett Learning.
Scholarly Activity Summary
This document describes the scholarly activity elements that
should be included in a five paragraph summary. You may use
this resource to help guide the preparation of the Scholarly
Activities assignment, due in Topic 10.
Overview
This section consists of a single paragraph that succinctly
describes the scholarly activity that you attended/participated
in, the target market for the activity, and the benefit of the
activity to you.
Problem
This section consists of either a short narrative or a list of
bullet points that concisely identifies the problems the scholarly
activity is designed to solve. Educate: What is the current state
of the activity topic? Explain why this is a problem, and for
whom is it a problem? Inspire: What could a nurse achieve by
participating in the scholarly activity? Use declarative sentences
with simple words to communicate each point. Less is more.
Solution
This section consists of either a short paragraph or a list of

bullet points that concisely describes the solution to a proposed
practice problem that the scholarly activity addressed and how
it addresses the problem outlined in the previous section.
Opportunity
This section consists of short paragraphs that define the
opportunity that the scholarly activity is designed to capture. It
is important to cover the objectives and goals that were met.
How will attending/participating in this scholarly activity help
you grow as a nurse?
Program Competencies Addressed
This section consists of a list of program competencies that
were addressed in this scholarly activity. Please use the list
from the ISP.
© 2017. Grand Canyon University. All Rights Reserved.
Running Head: STAFF SHORTAGE CAPSTONE PROJECT
CHANGE PROPOSAL
1
TYPE II DIABETES CAPSTONE PROJECT CHANGE
PROPOSAL
2
Benchmark - Capstone Project Change Proposal

Name: Liliana Faura
Course: NRS-490
Professor: Tish Dorman
Date: 2/2/20220
Background
The improvement of quality of life, and gains in medical
technology means that more Americans are living, as compared
to previous decades. However, the positive trends do not
discount the fact that more people are living unhealthier
lifestyles, as indicated by the research in 2016 that indicated
that eight in 10 Americans live with at least one chronic health
problem such as type II diabetes, hence there is call for dietary
and lifestyle changes to address the growing problem.
Problem Statement
Type II diabetes is caused majorly by poor lifestyle such
feeding habits, lack of physical exercise and sedentary life. To
address the challenge, healthcare experts recommend a number
of lifestyle changes such as exercising more and eating healthier
foods. Also, to implement the changes, patients are encouraged
to sustain the change process to realize better health outcomes,
a far as diabetes and other lifestyle diseases are concerned.
Purpose of The Change Proposal
The main purpose of the change proposal is to encourage
diabetic patients to assume an active role in addressing the

medical complication by engaging more practices that promote a
healthier living such as physical exercise, eating healthy,
encouraging behavior change such as quitting smoking and
excessive drinking. The change is geared towards helping
diabetic patients in the community to realize the benefits of
living a healthier life and help in managing diabetes.
PICOT
modifications.
Literature Search Strategy Employed
A literature search strategy a structure of keywords to look up a
database. The search strategy integrates the primary concepts to
search the PICO question to retrieve relevant and accurate

results. For this proposal, there are key terms and phrases that
are related to the question, and aids finding relevant literature
(see Appendix)
Evaluation of The Literature
Several scholars have dwelled on the need for management of
diabetes through lifestyle changes such as physical exercise,
and healthy living, and dietary practices (Glechner et al., 2018;
Gehlawat et al., 2018; Ryninks et al., 2015; Worku et al., 2015).
The issue of lifestyle changes has been a focus for years due to
its measurable success, and the minimal resources it requires to
implement the change process. The need to adequately focus on
behavior change is undeniably sufficient to argue in favor of the
same due to the increasing focus on the strategy for diabetes
management. Hoverer, the available literature on this important
topic needs to rethink the issue of sustaining the change
process, rather than solely focusing on the outcomes.
Applicable Change
Patient education about the need for lifestyle and dietary change
has been proposed by multiple health experts, who argue that
patient education has the potential to influence behavior change
in the long-term. Also, patient education, promotes a patient’s
understanding of diabetes, and factors that contribute to it such
as poor eating habits, sedentary life, excessive smoking, and
lack of physical exercise (Schneider et al., 2014).
In addition, Willis-Shattuck et al (2008) argue that that

increasing doctor reimbursement, as part of the efforts to
implement change process, is one of the changes needed in the
health care sector to promote the implementation of care
process for patients with diabetes. Such care processes may
include renal assessment, and blood and weight measurement on
a bi-annual basis. Also, the role of healthcare professional in
promoting care change such as teaching diabetic patients about
the need to go for eye checkup at least a year may help in
preventing new cases of diabetes in the community. Hence,
patient education is the most viable primary health care
practice, and aids in the implementation of lifestyle and dietary
change among diabetic patients.
Proposed Implementation Plan with Outcome Measures
Sustaining behavior change for diabetic patients is essential in
delivering positive healthcare outcomes. Numerous findings
have discovered the interrelationship between lifestyle and
dietary changes and the time taken to show signs of health
improvement. To achieve measurable success in terms of
behavior change, patients are enlightened about the importance
of behavior change sustainability. However, Schneider et al
(2014) posit that, behavior change is partly determined by how
the recent a patient has been diagnosed with the disease, and
how early diagnosis is help change behavior change in a
diabetic patient.
In addition, Pen et al (2008) argue that patient’s behavior

sustainability is shaped, in part, by the time of diagnosis - if it
is most recent, or the patient have been made aware if the
disease. Diabetes experts argue that, early diagnosis of the
disease if the reason why some of the patients will make it a
priority to adopt lifestyle changes in order to contain the
problem. Hence, implementing behavior change to include
lifestyle and dietary change needs to start with engaging the
patient in knowing the health status in advance, and to begin the
process of measurable process of behavior change.
Potential Barriers to Plan Implementation, And How to
Overcome Them
Implementing the change process is complex undertaking, which
requires dedicating sufficient resources to monitor behavior
change in diabetic patients. while some patients are committed
to behavior change, some may find it difficult to relapse and go
back to the old ways of living such as alcohol drinking,
smoking and other poor lifestyle choices. To overcome barriers
to change, healthcare professionals need to be part of the
change process by providing necessary moral support, and
ensuring that patients under the change program are carefully
monitored to prevent revisiting the old behaviors, and end up
not sustaining the change process. Also, changes such as
healthy eating be challenge to diabetic patients as their bodies
try to adapt to the new changes. To promote change

sustainability, a patient, therefore, need a demonstration of the
benefits of lifestyle and dietary for the sake of their health.
Conclusion
The policy framework of addressing the growing problem of
diabetes, and the need for health care professionals the
importance of behavior change, and especially dietary and
lifestyle changes. For patents with type II diabetes, achieving
the desired medical outcomes is the ultimate goal, even though
the process is time consuming and requires dedication, and
energy. Sustaining the change process, however, could be the
biggest challenge because most of the patients will drop out in
the process. Dietary and lifestyle changes, are the two important
behavior change in the management of diabetes.
References
Glechner, A., Keuchel, L., Affengruber, L., Titscher, V.,
Sommer, I., Matyas, N., ... & Gartlehner, G. (2018). Effects of
lifestyle changes on adults with prediabetes: A systematic
review and meta-analysis. Primary care diabetes, 12(5), 393-
408.
Gehlawat, M., Naik, B. N., Lakshminarayanan, S., & Kar, S. S.
(2018). Dietary practices and barriers to dietary modification
among diabetics and hypertensives in a rural health service area
of Puducherry: A qualitative study. International Journal of

Health & Allied Sciences, 7(3), 139.
Penn, L., Moffatt, M. & White, M. (2008). Participants’
perspective on maintaining behaviour change: a qualitative
study within the European Diabetes Prevention Study. BMC
Public Health, 8:235
Ryninks, K., Sutton, E., Thomas, E., Jago, R., Shield, J. P., &
Burren, C. P. (2015). Attitudes to exercise and diabetes in
young people with type 1 diabetes mellitus: a qualitative
analysis. PloS one, 10(10), e0137562.
Schneider, K., Andrews, C. & Hovey, M. (2014). Change in
physical activity after a diabetes diagnosis: opportunity for
intervention. Med Sci Sports Exerc, 46:84–91
Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L.,
Blaauw, D., & Ditlopo, P. (2008). Motivation and retention of
health workers in developing countries: a systematic
review. BMC health services research, 8(1), 247.
Worku, A., Abebe, S. M., & Wassie, M. M. (2015). Dietary
practice and associated factors
among type 2 diabetic patients: a cross sectional hospital based
study, Addis Ababa, Ethiopia. SpringerPlus, 4(1), 15

APPENDIX
PICO Literature Search Diagram
Literature Evaluation Table
Student’s name: Liliana Faura
University affiliation: GCU
Date: 12/15/219
Criteria
Article 1
Article 2
Article 3
Article 4
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
Weller, S. C., Baer, R., Nash, A., & Perez, N. (2017).
Discovering successful strategies for diabetic self-management:
a qualitative comparative study. BMJ Open Diabetes Research

and Care, 5(1), e000349.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530238/
https://journals.plos.org/plosone/article?id=10.1371/journal.pon
e.0137562
Fink, A., Fach, E. M., & Schröder, S. L. (2019). ‘Learning to
shape life’–a qualitative study on the challenges posed by a
diagnosis of diabetes mellitus type 2. International journal for
equity in health, 18(1), 19.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346523/
Messina, J., Campbell, S., Morris, R., Eyles, E., & Sanders, C.
(2017). A narrative systematic review of factors affecting
diabetes prevention in primary care settings. PloS one, 12(5),
e0177699.
e.0177699
Article Title and Year Published
The article relates to the PICOT question as it describes the
strategies that can be used in managing diabetes.
The article relates to the PICOT question as it discusses

attitudes and exercises that can be used by young people with
Type 1 Diabetes Mellitus.
The article relates to the PICOT question as it provides about
challenges of diagnosis of diabetes mellitus type 2
The article relates to the PICOT question as it discusses the
factors that affect diabetes prevention in a primary care setting.
Research Questions (Qualitative)/Hypothesis (Quantitative), and
Purposes/Aim of Study
What strategies can be used in diabetic self-management?
Aim: to explore patients lifestyle in good and poor control to
identify practices and strategies that lead to a successful
diabetes management
What’s young people’s attitudes to physical activity on
glycaemic control in Type 1 Diabetes Mellitus
Aim: to investigate attitudes of young people to and
understanding of physical activity on glycaemic control in Type
1 Diabetes Mellitus
What are the challenges associated with a diagnosis of type 2
diabetes for those affected
Aim: To investigate the challenges that are associated with type
2 diabetes diagnosis
What are the factors related to the delivery and uptake of type 2
diabetes prevention interventions

Aim: To understand the factors that are related to delivery and
uptake of type 2 diabetes prevention intervention
Design (Type of Quantitative, or Type of Qualitative)
This article is qualitative research
This article is a qualitative analysis
This article is a qualitative study
This article is a narrative systematic review
Setting/Sample
Healthcare setting- university-affiliated Family Medicine
Clinics in Galveston, Texas
The Bristol and Weston Paediatric Diabetes Service
Halle/Saale, Saxony-Anhalt, Germany
Healthcare setting
Methods: Intervention/Instruments
Open-ended questions
Use of focus groups
Interviews
Revision inclusion and exclusion criteria

Analysis
The ideas presented were coded and verified independently.
AIC was acquired from patient medical records. The ideas and
themes were also estimated for each three glycemic control
groups
The focus groups were transcribed by a research assistant and
the patient identifiable details were removed. Super-ordinate
and master themes were developed through refining and
clustering
Personal data was protected by pseudonyms. Data management
and analyses were done with the use of MAXQDA software.
Data was broken down into parts, examined and compared.
The traditional systematic reviews focused on the measure of
effectiveness which helped in the provision of good quality
evidence-based data. data analysis was guided by narrative
synthesis and thematic analysis
Key Findings
Patients who did not their medications as prescribed were in
poor control. Patients who tested two or more times a day were
in good control.
Exercises helped in managing young people’s diabetes.

Difficulties at school and misunderstandings were reported to
impact diabetes in their life.
Diabetes mellitus type 2 affected professional and private life.
The process of learning to shape life was the central
phenomenon for the participants who were interviewed.
The risks of diabetes were linked with family history, obesity,
and lifestyle. Other factors identified were diet and physical
activity. Some participants stated that diabetes progression was
linked to genetics, stress and social isolation while others
believed that diabetes was widespread.
Recommendations
More emphasis on the importance of information and accuracy
should be improved.
More opportunities should be provided to empower young
people to take on responsibility for their Type 1 Diabetes
Structured diabetes education should be accessible to all
persons with T2DM
Further research is needed for the prevention and optimal
provision of knowledge for patients and professionals.
Explanation of How the Article Supports EBP/Capstone Project
It identified lifestyle strategies that can help manage type 2

diabetes.
It supports the project as it promoted awareness of the physical
and psychological benefits of exercise in managing diabetes
It supports the project as it has provided recommendations on
self-management to control diabetes.
It has identified factors that can be used in preventing diabetes
in primary care.
Criteria
Article 5
Article 6
Article 7
Article 8
Author, Journal (Peer-Reviewed), and
Permalink or Working Link to Access Article
408.
https://www.sciencedirect.com/science/article/pii/S1751991818
301967
Chen, J., Jing, X., Liu, X., Volkmann, A. M., Chen, Y., Liu, Y.,

... & Han, N. (2019). Assessment of factors affecting diabetes
management in the City Changing Diabetes (CCD) study in
Tianjin. PloS one, 14(2), e0209222.
e.0209222
http://www.ijhas.in/article.asp?issn=2278-
344X;year=2018;volume=7;issue=3;spage=139;epage=144;aulas
t=Gehlawat
practice and associated factors among type 2 diabetic patients: a
cross sectional hospital based study, Addis Ababa, Ethiopia.
SpringerPlus, 4(1), 15.
https://springerplus.springeropen.com/articles/10.1186/s40064-
015-0785-1
Article Title and Year Published
The article relates to the PICOT question as it discusses the
effects that lifestyle changes on prediabetes in adults.
The article relates to the PICOT question as it assesses the

factors that affect the management of diabetes.
The article relates to the PICOT question as it describes the
dietary practices and barriers that exist in modifying diet among
diabetic patients
The article relates to the PICOT question it assesses about the
dietary practices and factors that are associated with type 2
diabetic patients
Research Questions (Qualitative)/Hypothesis (Quantitative), and
Purposes/Aim of Study
What are the effects of lifestyle changes on adults with
prediabetes
Aim: to assess lifestyle intervention in comparison with
treatment in people with prediabetes
What are the factors that affect diabetes management in the City
Changing Diabetes in Tianjin
Aim: identification of local levels of vulnerability among
patients with Type-11 diabetes in Tianjin
What are the dietary practices and barriers presented to dietary
modification among diabetes hypertensive
Aim: to describe awareness of healthy dietary practices among
diabetic patients
What are the dietary practice and associated factors among type
2 diabetic patients

Aim: To describe the dietary management amongst type 2
diabetic patients
Design (Type of Quantitative, or Type of Qualitative)
This article is a meta-analysis research
This article is a cross-sectional research
Setting/Sample
Healthcare setting
Healthcare setting in Tianjin
Healthcare setting
Outpatient Department of Yekatit 12 Medical College Hospital,
Addis Ababa, Ethiopia
Methods: Intervention/Instruments
Literature analysis
Interview
Focus group discussion

Use of questionnaire and interview
Analysis
Evidence was summarized by a narrative format due to the
insufficiency of data for meta-analysis. Publication bias was
assessed using funnel plots, Egger’s regression intercept and
Kendall’s S static.
The records were transcribed into text and imported into NVivo
software. It was analyzed according to TCA.
Transcripts were reviewed independently by the authors by the
iterative process. intuitive coding was used for manual content
analysis
Data were analyzed manually for completeness. The
independent variables were selected into the model-based in the
literature, conceptual framework and effect on their analysis
Key Findings
Individuals with prediabetes who received lifestyle intervention
had a 54% lower risk of progression to type 2 diabetes than
people receiving the usual treatment.
After summarization of themes, it was concluded that certain
situations influenced wellbeing, health or emotions. Low
literacy was identified as a factor that limited the ability of

participants to manage their disease effectively.
The dietary modification was identified as essential if it makes
an impact on sugar control. Support from family members was
identified as a determinant of change in dietary behavior.
21.4% of the population had poor dietary practice. 16.6% of the
respondents provided that foods were not prepared based on
their disease.
Recommendations
Individuals with type 2 diabetes should consider lifestyle
intervention as it is a safe and cost-effective means.
Specific interventions that target an individual patient, family,
community and society are needed in improving diabetes control
Individuals with chronic diseases such as diabetes should
eradicate barriers such as consuming unhealthy foods.
Healthcare services should empower patients to heal themselves
by facilitating lifestyle changes through the use of health
promotion.
Explanation of How the Article Supports EBP/Capstone
It has provided that lifestyle intervention is the safest method
that can be used in reducing diabetes.
It supports the capstone as it has provided interventions that can

be used in improving diabetes control
It has provided the importance of dietary self-management in
controlling diabetes
It was suggested that the production of vegetables and fruits
will help in reducing diabetes.
References
Chen, J., Jing, X., Liu, X., Volkmann, A. M., Chen, Y., Liu, Y.,
... & Han, N. (2019). Assessment of factors affecting diabetes
management in the City Changing Diabetes (CCD) study in
Tianjin. PloS one, 14(2), e0209222.
Fink, A., Fach, E. M., & Schröder, S. L. (2019). ‘Learning to
shape life’–a qualitative study on the
challenges posed by a diagnosis of diabetes mellitus type 2.
International journal for equity in health, 18(1), 19.

408.
Messina, J., Campbell, S., Morris, R., Eyles, E., & Sanders, C.
(2017). A narrative systematic review of factors affecting
diabetes prevention in primary care settings. PloS one, 12(5),
e0177699.
Weller, S. C., Baer, R., Nash, A., & Perez, N. (2017).
Discovering successful strategies for diabetic self-management:
a qualitative comparative study. BMJ Open Diabetes Research
and Care, 5(1), e000349.
practice and associated factors among type 2 diabetic patients: a
cross sectional hospital based study, Addis Ababa, Ethiopia.
SpringerPlus, 4(1), 15.

Running head: PICOT STATEMENT
1
PICOT STATEMENT
2
Picot Statement
Liliana Faura
GCU
Professional Capstone and Practicum
12/08/2019
PICOT Statement
modifications.

Introduction
According to the World Health Organization, diabetes is one of
the most serious conditions that affect a significant percentage
of individuals in the worldwide population. It is estimated that
more than 400 million people in the world are likely to be
diagnosed with diabetes, while those that have not been
diagnosed totaling to the same number. Although diabetes can
be attributed to hereditary conditions during a person’s life,
what is more, devastating is the increase in cases of diabetes
type II, which is usually preventable, affecting more than 90%
of individuals with diabetic conditions in the world (Abbade et
al., 2017). This put a lot of questions on the effectiveness of the
current assessment techniques and procedures applied to control
the condition in the world. Diabetes II is usually attributed to a
high intake of processed foods that are mostly sugary.
Picot Statement
Population
Adults with early type II diabetes are more likely to be obese,

whereby most of them are usually women. The type II diabetes
is an epidemic especially in the US whereby it is estimated to
have increased by 70% in adults. Research has estimated that
close to 80% of individuals with diabetic conditions live in
middle and low-income countries (Abbade et al., 2017). China
had the highest number of individuals with diabetes, followed
by India with more than 10% of individuals with diabetic
conditions. Over the last three decades, there has been an
increase in cases of diabetes prevalence, which has been noted
at all ages, although the adults are more disadvantaged.
Intervention
Evidence-based intervention that seeks to reduce both childhood
and adulthood diabetic incidences should target the preventive
and treatment measures. Patient-level interventions usually
include those directed at improved self-management including
taking medication, proper diet and exercise and self- monitoring
in the use of health care services. Professional education and
knowledge activities are examples of strategies that can be put
in place to cope with the condition. Since interventions are
designed for the general population, the disadvantaged groups
may not be able to take full advantage of the opportunities
(Boswell & Cannon, 2018). In some cases, interventions may
include change of school curriculum for students whereby
physical education, change in meal provisions and physical

exercise is usually encouraged.
Comparison
Since the physician is a member of the multidisciplinary team,
then standardized care in support of good care is likely to be
provided to ensure there is a healthy community. The physician
plays a greater role in ensuring there is proper access to
medicare through provision checkup services and screening
services to help in the diagnosis of the disease (Boswell &
Cannon, 2018). Individuals should focus on ensuring there is a
healthy living and the need to expand the role of health care
providers.
Outcome
When a physician is involved as one of the members of the
multidisciplinary team approach, then there is guaranteed better
care for an individual. The outcomes from the intervention
should include a reduction in cases of diabetes and the risks
related to the disease with the provision of affordable healthcare
services.
Time
The treatment of diabetes, especially type II, should take
approximately three months. The reason being that the focus is

usually on general behavior patterns of individuals. Therefore,
interventions should aim at the promotion of long term
outcomes.
Reference
Abbade, L. P., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L.,
& Thabane, L. (2017). The framing of research questions using
the PICOT format in randomized controlled trials of venous
ulcer disease is suboptimal: A systematic survey. Wound Repair
and Regeneration, 25(5), 892-900.
Boswell, C., & Cannon, S. (2018). Introduction to nursing
research. Jones & Bartlett Learning.

Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx

Recommended

Recommended

More Related Content

Similar to Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx

Similar to Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx (20)

More from healdkathaleen

More from healdkathaleen (20)

Recently uploaded

Recently uploaded (20)

Running Head LITERATURE REVIEW 1LITERATURE REVIEW 5.docx