Essay on "Type II Diabetes in Adults"

Essay 7 pages (1899 words) Sources: 6

[EXCERPT] . . . .

Diabetes: PICO Search Strategies and Results

Electronic databases are able to efficiently collect and collate a far greater amount of information and specific articles than would be feasible or practical for even the most extensive and dedicated physical research library. The digital age has enables databases not only to retain full-text and abstract records from countless journals and other sources, but also to allow key-word searches and other means of locating information in this vast store of knowledge. With paper records, such a research-friendly system would require a team of full-time readers keeping careful track of every topic discussed in thousands of monthly and weekly periodicals. But though there are amazing advantages to electronic databases, there are also some marked difficulties in finding information for specific questions that are directly relevant.

This fact is made very clear when attempting to research the question, "How do diet and exercise influence glucose levels and improve quality of life in patients with type II diabetes?" The question itself is fairly simple and very straightforward, yet finding articles in medical databases that directly answer the question is anything but simple and straightforward. If the search is too specific, no results might be found, but too broad and many of the results will not be relevant to the research questions. Searches using too many terms -- "diet," "glucose," "diabetes type II," and "quality of life" returned few to no results on the databases searched in an attempt to answer this question. Other four-term queries yielded similar results. Generally, three-term queries with simplified terms (i.e. "diabetes" instead of "diabetes type II") yielded the best results, and though many hits were irrelevant, it was simple to pick out the more useful ones.

Medline Plus Search Results

Mayo Clinic Staff. (2009). "Diabetes management: How lifestyle, daily routine affect blood sugar." Mayo foundation for medical education and research.

This expert opinion article has both qualitative and quantitative elements, discussing both generalized and subjective patient responses as well as actual cause-and-effect numerical relationships. The population includes almost all patients with diabetes, as the "setting" is truly a broad review of existing literature and practice. The interventions examined include both dietary recommendations, lifestyle adjustments, and exercise habits, as well as frequent check=ups with a physician during periods of transition and change. In sum, that article discusses general self-care and maintenance practices for the patient. It addresses the PICO question fairly directly, although it does not discuss the direct effect on glucose levels. The strength of the evidence lies largely with the renown of the institution that produced the article, but is quite high for it.

Mayo Clinic Staff. (2009) "Diabetes -- create your healthy eating plan." Mayo foundation for medical education and research.

This is a far more specific and quantitatively detailed expert opinion article. The population is again the general population of patients with diabetes, and the setting is extensive literature and practical review -- the article is essentially a detailed guide of established best practices, with the direct effects of these practices detailed. The interventions listed are basic dietary changes, including the regulation of mealtimes and the proportion of carbohydrate, proteins, and fats recommended. This includes specific food item comparisons. This more directly answers a portion of the PICO question, with measures of glucose level effects of certain eating habits/intake given quantitatively, as well as a more specific discussion of quality of life factors as affected by diet. The strength of the evidence again relies on the institution producing the information.

Imamura, F; Lichentenstein, a.; Dalal, G.; Meigs, J. & Jacques, P. (2009). Generalizability of dietary patterns associated with incidence of type 2 diabetes mellitus. American journal of clinical nutrition 90(4), pp. 1075-83.

This research study was conducted by collating and quantifying the results of several previous experimental and observational studies concerning dietary patterns and the development of type II diabetes. The results is a quantitative analysis of a wide population of people with type II diabetes, and includes their dietary patterns before the onset of the condition. Interventions discussed were wholly dietary and non-medical, in that they examined patients' non-regulated or instructed eating habits and noted trends that increased the risk for developing type II diabetes. The results showed that meat, refined grains, and soda were all predictive, while fired foods, eggs, and alcohol were only partially predictive. Though this reveals certain dietary information regarding diabetes, it is not highly relevant to the PICO question. The evidence, however, is based on extensive empirical research and is therefore quite strong.

CINAHL Plus Search Results

Wallach, J. & Rey, M. (2009). "A socioeconomic analysis of obesity and diabetes in New York City." Preventing chronic disease 6(3).

This case study of one city's rising rates of obesity and diabetes is primarily quantitative, though there are qualitative elements as well. The population studied was the general population of New York, as recorded over a decade by public health agencies; the setting consisted of extensive review and analysis of previously published and established information. A clear link between weight, exercise levels, and type II diabetes is established, implying interventions of increased exercise and weight loss as preventative measures. The results show that despite increases in other health measures, obesity and diabetes are both still on the rise in New York City. Though the evidence in the study is quite compelling, and relevant to both dietary and exercise information, it does not directly address the PICO question insofar as glucose levels, though it is on target with a quality of life discussion.

Gulve, E. (2008). "Exercise and glycemic control in diabetes: Benefits, challenges, and adjustments to pharmacotherapy." Physical therapy 88(11), pp. 1297-321.

This is a research study that tries to remain fully quantitative, but due to the variations in results is at least somewhat qualitative. Population was again focused on those with type II diabetes generally, as the setting for this study was yet again a review of existing literature and experimental data, collated here to provide clearer and more definitive results. Different types of exercise (specifically aerobic exercise and resistance training) were examined for their effects on glucose levels in those with type II diabetes, and interventions as well as cautionary advice were listed along these lines; though exercise is generally a frontline defense against complications and progression of type II diabetes, it can also pose some dangers due to its alteration of glucose levels. Aerobic training has long been known to be effective, but this study shows that resistance training can also be very beneficial at controlling glucose levels as long as careful monitoring is done during the exercise period. These findings are highly relevant to the PICO question, illuminating some precise and specific effects of different kinds of exercise on glucose levels, and thus on the quality of life of a patient with type II diabetes. The evidence is also quite strong, as there is an abundance of empirical data offered from which the author makes his claims.

Google Scholar Search Results

Eriksson, K. & Lindgarde, F. (1991). "Prevention of Type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise: The 6-year Malmo feasibility study." Diabetologia 34(12), pp. 891-8.

In this quantitative case study, a population of men in Malmo, a city in Sweden, who had been identified as at risk for developing type II diabetes were followed for several years to see what the effects of dietary and exercise intervention could have on preventing full onset of the disease. The men were all middle-aged, in their forties at the time that the study began, and the basic setting for the study was simply their home life. Clinical visits were used to assess health and progression of diabetes as well as effectiveness of interventional methods, which consisted of regimented dietary constraints and exercise plans. In general, however, the setting consisted of the daily life of these men over the six-year period of the study, and interventions were not strictly implemented but rather recorded after the fact according to the level of adherence, and the results were analyzed to determine how effective certain interventions were t preventing onset of type II diabetes. Both exercise and diet were found to be effective, but although the study provides very clear evidence in support of its results, this study is not especially relevant to the PICO question as it addresses the effects of diet and exercise in the prevention of diabetes, and not on glucose levels during the progression of the disease.

Karter, a.; Ackerson, L.; Darbinian, J.; D'Agostino, R. & Ferrara, a. "elf-monitoring of blood glucose levels and glycemic control: The Northern California Kaiser Permanente Diabetes registry." American journal of medicine 111(1), pp. 1-9.

This study consisted of direct experimentation with a group of individuals with type II diabetes, providing quantitative results on the effectiveness of self-monitoring as a way of maintaining proper glucose levels. The population consisted of over twenty-thousand patients diagnosed through various institutions; the study setting was again their day-to-day life, and data was collected via subject responses to the researchers.… READ MORE

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