According to Waryasz & McDermott (2009), the global prevalence of diabetes among people aged between 20 and 79 rose to 6.4% affecting 285 million people in 2010 and the rate will rise to 7.7% affecting 439 million people by 2030. Amid 2010 and 2030, the rate of individuals with diabetes will increase by 69% in developing nations, and a twenty percent rate in developed nations. In 2011, the number rose to 366 and it is expected to rise to 552 by 2030. The pervasiveness of diabetes is advanced in males compared to females, yet the number of women with diabetes is more compared to that of men.
Diabetes affects any part of the human body and people with diabetes are likely to die of heart-related problems or stroke. Seventy-percent of individuals with diabetes show signs of high blood pressure which a risk factor for heart-related diseases. The majority of people with diabetes have type 2 diabetes. The stunning rise in the occurrence of type 2 diabetes is being paralleled through an equally alarming rise of obesity. Obesity is one of the common risk factors for type 2 diabetes. The public health community, both international and national, has been very sluggish to acknowledge the huge public health and socioeconomic threats of diabetes and it is ruining complications such CVD, retinopathy, neuropathy and nephropathy.
However, the World Health Organization has recognized diabetes and its large socioeconomic and personal costs as a foremost society and global health problem. The Health Department in New York confirmed that 5, 695 people passed on because of diabetes linked causes in 2011. In every 90 minutes, one person dies of diabetes and sixteen diabetes-related deaths are recorded every day in New York. Diabetes is a major risk factor for life-threatening diseases such as stroke and heart attack, over four million persons die from diabetes every year, and the number is constantly rising with a higher number of diabetes-linked deaths linked to the elderly. These grim statistics are linked to obesity complications given that 85% of individuals with diabetes are overweight.
PICO is a technique of combing a search plan that permits one to take more proof-based perspective to literature search.
P: Population or patient
A PICO format is a dependable formula for forming questions, which can be answered and researched easily in a clinical setting. A well-formed question identifies the population or patient's problem, make out the intervention, identify the major alternative that is to be considered and ends with a specific outcome that identifies the plan one wishes to accomplish.
All African-American patients with type 2 diabetes (both males and females) (P) who adapt healthy eating habits, physical activities, lowered hemoglobin A1C values, and self-monitored behavior to reduce T2DM risk factors (I) compared to those who use medical and counseling therapy (C) enhance management of blood glucose through controlling their cholesterol level and blood pressure.
The above PICO Format is founded on the prevalence of type two diabetes and the increased death rates caused by complications of this type of diabetes. The PICO format development was after a thorough assessment of causes, risk factors, complications and management of type diabetes whose prevalence is to further increase by 2030. The majority of people with type 2 diabetes are overweight and conventional therapy seems not to be effective in the management of this type of diabetes. According to a study carried out in 2002 by Karin et al., most patients suffering from type diabetes don not engage in physical activities and they do not follow dietary guiding principles for vegetable, sugar, carbohydrates, fruit and fat consumption. Physical activities enhance dietary habits in people with type 2 diabetes. Weight increases insulin resistance in type 2 diabetes and insulin hold lowered impacts on cells of muscles so that each cell becomes unable to take in the glucose. The glucose remains in the blood where it attains increased levels that are dangerous to one's health. According to Waryasz & McDermott (2009), exercise, diet, healthy conducts and lifestyles are crucial elements of the treatment plan for people with type 2 diabetes, and they call for self-care. Proper utilization of exercise and diet improves glycemic control and insulin sensitivity thereby decreasing the requirement for insulin or oral medications.
Literature Review: Literature Search
To confirm the relevance of the PICO format appropriately, a thorough search for scholarships and peered reviewed journals, which offered to substantiate information regarding the cause, treatment, management, risk factors and complications of type 2 diabetes, was conducted. Among the sources searched and consulted included journals from EBSCOhost, the internet and American diabetic associations. The first research article," Diet and Exercise Among Adults With Type 2 Diabetes: Findings from the Third National Health and Nutrition Examination Survey (NHANES III)" written by Karin et al. is a British Medical Journal searched through the internet. The search used effectiveness of diet and exercise in treating type 2 diabetes as the key words. The article is a primary source that offers the significance of including healthy eating habits and exercises all components of self-care management in the management and treatment of type 2 diabetes.
The second journal article is" Reappraisal of Metformin Efficacy in the Treatment of Type 2 Diabetes: A meta-Analysis of Randomized Controlled Trials." The search utilized causes and treatment of type 2 diabetes from EBSCOhost. This PLoS Medicine journal confirms that metformin treatment alone increases mortality in overweight patients with type 2 diabetes. The article is a primary source that stressed on combined with conventional therapy; self-care, exercise and diet in treating type 2 diabetes in overweight patients.
The third journal" Exercise prescription and the patient with Type 2 Diabetes: A Clinical Approach to Optimizing Patient Outcome written by Waryasz & McDermott (2009) is a review journal article that confirms importance of physical activity, self-care and diet in enhancing the overall well-being and health of patients with Type 2 diabetes. The article is a Journal of the American Academy of Nurse Practitioners, and it is a secondary source searched through EBSCOhost. The fourth article consulted in this research is "Psychological resistance to insulin therapy in adults with type 2 diabetes: Mixed-method Systematic Review." The journal article written by Wang & Yeh (2011) is a primary source derived from EBSCOhost. It confirms the ineffectiveness of insulin therapy alone in treating and managing type 2 diabetes.
According to Waryasz & McDermott (2009), the current epidemic of type 2 diabetes is projected to augment to over three million people world word by 2025. The U.S. presently has over 40 million prediabetics aged between 40 and 74, and a great functional reduction will take place in this populace if their condition progress to diabetes. Insulin resistance and poor glycemic control are usually present in type 2 diabetes, besides potential hyperlipidemia, hypertension and preatherosclerosis. Given these complications, these patients are subjected to coronary heart diseases, peripheral vascular diseases, microvascular diseases and cerebrovascular accidents (Waryasz & McDermott, 2009).
Tight glycemic become the objective of and therapeutic regimen to facilitate reduction of the onset of the complications linked to T2DM. Patients with T2DM report knowledge and attitudes of how to obtain improved health, but these patients do not necessarily utilize this knowledge to generate healthier conducts with regard to exercise, weight and nutrition management. Approximately two-thirds of patients with T2DM reports involvement in physical actions, but only 40 to 43% of these patients attain the ADA (American Diabetes Association) physical activity standards. Waryasz & McDermott (2009) assert that stresses on the advantageous role of physical activities for both T2DM patients and their relations lower the risk of contacting T2DM. Augmenting physical activities in the prediabetic populace are twice efficient as standard medical care and metformin in lowering the probability of developing T2DM.
Physical activities lead to 65% risk reduction and reduction in the intrinsic risk of developing T2DM is linked to weight management. Waryasz & McDermott (2009) further asserts that all immunological and biochemical shifts linked to T2DM are not fully comprehensible. Ectopic adipose tissue in the liver, pancreas and muscle increases free fatty acids in the obese and intramuscular adipose deposits depressingly affects the glucose shuttle into the cell. According to Waryasz & McDermott (2009), exercise and healthy eating and healthy lifestyles counter the impacts of insulin resistance, T2DM and obesity. Through a systematic review of existing literature on significance of physical exercises and healthy eating habits (Waryasz & McDermott (2009), ascertains that T2DM is effectively managed through exercise, healthy habits, healthy lifestyles and health eating compared to insulin therapy alone.
Boussageon et al. (2012) through randomized controlled trials assessed the effectiveness of metformin against mortality or cardiovascular morbidity in T2DM patients and their findings indicated that metformin does not greatly influence the major upshots of all-cause mortality and cardiovascular mortality. The authors ascertained that despite the perceived effectiveness of metformin in treating T2DM, its risk/benefit remains indecisive. The treatment increases the T2DM linked mortality by 31% and lowers the reduced rate by 25%,…