Evidence Based Practice Articles Synthesis Summary

Synthesis/Summary of Evidence Based Practice Articles
Introduction
A life-long disease, diabetes tends to affect the way an individual’s body handles blood glucose. In essence, type 2 diabetes happens to be the most prevalent kind of diabetes. It is important to note that various research studies have been undertaken in the past in an attempt to not only figure out the risk factors of diabetes, but also assess the best approaches towards the management of the same. This text concerns itself with three articles focusing on type 2 diabetes. In so doing, it will uncover the various risk factors for type 2 diabetes, assess the management of type 2 diabetes (with a bias on the appropriate diet), and evaluate the most appropriate nutritional choices to be made in relation to older people with diabetes.
Discussion
Ley, Korat, Sun, Tobias, Zhang, Qi, Willett, Manson, and Hu (2016), provide critical data on not only the role diet plays in the development of type 2 diabetes, but also the role other factors such as genetics, biomarkers, as well as lifestyle in the same. According to Ley et al. (2016), the number of adults living with diabetes in the world is estimated to be 415 million. As the authors further point out, this is a figure expected to rise to 642 million within the next two decades. In that regard, therefore, the relevance of implementing the appropriate interventions to rein in the situation cannot be overstated. Tay, Luscombe-Marsh, Thompson, Noakes, Buckley, Wittert, Yancy, and Brinkworth (2015) are of the opinion that to combat diabetes, which has become a global epidemic, there is a need to not only formulate but also implement effective strategies. Unger (2013) is of the opinion that the condition ought to be considered a critical public health concern. Today, “nearly 12% of global health expenditures are devoted to diabetes-related treatments, and the United States alone accounted for $348 billion in 2015” (Ley et al., 2016, p. 1624).
Some of the risk factors for type 2 diabetes identified by the Nurses’ Health Study (NHS) include diet, adiposity, as well as other lifestyle factors. With regard to adiposity, which is in essence a severe obese condition, Ley et al. (2016) are of the opinion that this remains the most prominent risk factor with regard to diabetes, as per the NHS cohorts. In this case, “type 2 diabetes risk rose as excessive body fat increased, starting from the lower end of a healthful body mass index (BMI) or waist circumference” (Ley et al., 2016, p. 1625). When it comes to diet, it is important to note that this has been linked to not only the development, but also the progression of type 2 diabetes for a long time (Unger, 2013). NHS, according to Ley et al. (2016) associated diets favoring oils that are plant based, enhanced n-6 polyunsaturated fatty acids intake, enhanced zinc and magnesium intake, and fiber-rich diets with decreased type 2 diabetes risk. Further, also lowering the risk of type 2 diabetes was enhanced whole grain intake.
It should, however, be noted that increased consumption of red meat as well as sugar-sweetened beverages was linked to a higher risk for type 2 diabetes (Ley, et al., 2016). In the words of Ley et al. (2015), “a dietary intervention is a cornerstone of diabetes management with guidelines indicating dietary patterns varying in macronutrient composition may offer individualized approaches for treatment” (1628). It is, however, important to note that as the authors point out, of key consideration on this front is how effective various diets are in this endeavor. In their study seeking to compare low- and high-carbohydrate diets for the management of type 2 diabetes, Tey et al. (2015) found out that “hypocaloric, energy-matched LC and HC diets administered as part of a holistic lifestyle-modification program incorporating regular exercise achieved substantial weight loss, improved glycemic control, and reduced CVD risk factors in obese adults with T2D” (782). The authors further point out that the LC diet, in comparison to the HC diet, had better outcomes with regard to “greater reductions in diabetes medications and enhanced improvements in diurnal blood glucose stability and the lipid profile” (Tey et al., 2015, p. 783).
According to Ley et al. (2016), “physical inactivity is now a well-accepted risk factor for type 2 diabetes, and the NHS cohorts have provided strong supporting evidence” (1626). This is yet another risk factor that has been well-researched in the past. Ley et al. (2016) observe that in the NHS, an inverse relationship between type 2 diabetes and moderate to high-intensity exercise was observed. In contrast, however, those whose behaviors and lifestyles were sedentary had a higher risk of type 2 diabetes (Ley et al. 2016). Other lifestyle factors associated with a higher risk for type 2 diabetes include, but they are not limited to, exposure to active as well as passive cigarettes smoke and sleep quality/quantity (less or equal to 5 hours of sleep or more or equal to 9 hours of sleep) (Ley et al. 2016).
It is important to note that in the past, various other risk factors for type 2 diabetes have been identified. These include, but they are not limited to novel biomarkers, genetic factors, reproductive factors, and psychosocial factors (Ley et al., 2016). Also, as Phillips and Phillips (2014) point out, the prevalence of diabetes also increases with age.
As it has already been pointed out elsewhere in this text, the relevance of diet in diabetes management cannot be overstated. This has also been restated by Tey et al. As the authors point out, HbA1c improvements as well as weight loss were closely associated with both HC and LC diets. It is, however, important to note that the LC diet (when compared to the HC diet) had what Tey et al. (2015) termed better effects on not only HDL cholesterol, but also on triglycerides as well as “glycemic control as shown by lower diabetes medication requirements and greater attenuation of diurnal blood glucose fluctuation” (785). In that regard, therefore, the findings by Tey et al. indicate that in the long-term, and in relation to the management of type 2 diabetes, there are more benefits to be derived from LC diets containing low-saturated and high-unsaturated fat contents.
In their study seeking to investigate diabetes in older people and the role nutrition plays as an intervention and management measure, Philips and Philips (2014) are of the opinion that the incidence of diabetes has been on the increase as the number of persons that require nursing as well as residential home care increases. According to the authors, this is indicative of the need to recognize or identify the various nutritional aspects of the management and care for diabetes, while also highlighting the critical role of nutrition as far as the health of individuals is concerned in the later stages of their lives (Philips and Philips, 2014).
It should, however, be noted that as Philips and Philips (2014) point out, diagnosing diabetes in older adults is often a challenge. This is more so the case given that they might not necessarily present with the usual diabetes symptoms. For instance, as Shah et al. (as cited in Philips and Philips, 2014) observe, “the renal threshold for glucose increases with age, so glycosuria (glucose present in urine) is less easy to detect” (374). With regard to diet and nutrition, various considerations also ought to be made relating to the age. This is more so the case given that as Phillips and Phillips (2014) observe, “appetite changes and ageing processes altering thirst detection and taste also affect nutritional needs among older people with diabetes” (p. 376). There is also need for a comprehensive assessment of the health status of individuals aged 70 and above once diagnosed with type 2 diabetes. This is more so the case given that as Abbatecola and Paolisso (as cited in Phillips and Phillips, 2014) point out, “with increasing age, post-meal glucose rises are the initial abnormality that, coupled with glycemic variability, can cause increased risk of vascular complications” (374).
Conclusion
The cost of diabetes is significant – both at an individual level and as a public health concern. For this reason, there is need for more studies to be conducted on the most effective diabetes management approaches, while at the same time properly assessing the various risk factors associated with the condition as a way of further enhancing the validity of conclusions arrived at with regard to effective diabetes management. The NHS data, as has been highlighted by Ley at al., is also crucial in seeking to develop proper understanding of type 2 diabetes risk factors. There is sufficient scientific evidence to promote policies as well as guidelines that seek to enhance healthy eating and encourage physical exercises as ways of preventing type 2 diabetes. Philips and Philips vouch for the enhanced awareness of nutritional guidelines in an attempt to implement an effective diabetes management approach. This is largely important as dehydration and malnutrition are deemed dangerous for persons with diabetes, particularly those over 70 years old.









References
Ley, S.H., Korat, A.V., Sun, Q., Tobias, D.K., Zhang, C., Qi, L., Willett, W.C., Manson, J.E. & Hu, F.B. (2016). Contribution of the Nurses' Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics. American Journal of Public Health, 106(9), 1624-1630.
Phillips, A., & Phillips, S. (2014). Diabetes in Older People: Making the Right Nutritional Choices. Nursing & Residential Care, 16(7), 372-376.
Tay, J., Luscombe-Marsh, N.D., Thompson, C.H., Noakes, M., Buckley, J.D., Wittert, G.A., Yancy, W.S. & Brinkworth, G.D. (2015). Comparison of Low- and High-Carbohydrate Diets for Type 2 Diabetes Management: A Randomized Trial. The American Journal of Clinical Nutrition, 102(4), 780–790.
Unger, J. (2013). Diabetes Management in Primary Care (2nd ed.). Philadelphia, PA: Wolters Kluwer.