management of type 2 diabetes Literature Review

Literature Review for Capstone Project
Introduction
In the management of type 2 diabetes (T2D), medication adherence is a crucial issue. One of the strategies to ensure medication adherence among T2D patients is nurse-led intervention meant to change the behavior of patients. This study, therefore, seeks to determine how a nurse-led behavior change intervention compares to standard care in patients with T2D in increasing adherence to medication in a period of four months. This section is a literature review that analysis eight literature materials.
A comparison of research questions
In all the articles, the research questions incorporate the aspect of nonadherence to medication/management strategies, however, there are varying aspects in the details of each research question. In Costa et al. (2015), the study focused on chronic diseases in general, and not specifically on T2D. In Whitehead et al. (2017), the intervention is not led by nurses and it not only limited to T2D but also includes mental health. Guo et al. (2019) have a research question that is not clear on whether the intervention sought to affect medication adherence. In the research by Supachaipanichpong et al. (2018), the intervention was education, which is not stated on whether it is nurse-led. On the other hand, Sapkota et al. (2015), seeks to determine whether nonadherence affect diabetes therapy, therefore, there is no intervention included. While behavior change in Balducci et al. (2019) is considered as an effective solution in improving medication adherence, the research seeks to identify whether the behavior change would last into the long-term. Contrary to Balducci et al. (2019), Johansen et al. (2017) sought to determine whether lifestyle intervention can maintain glycemic control in patients with T2D. Lastly, in Mohd et al. (2016), the intervention is not nurse-led. This notwithstanding, it is obvious that the various research questions surrounding the concept of medication adherence and improving health outcomes, which makes the studies relevant to the current research question.
A comparison of sample populations
In both Costa et al. (2015) and Sapkota et al. (2015), the study utilizes a systematic literature review methodology with the population being studies published on behavior intervention. In all the other studies (Whitehead et al., 2017; Guo et al., 2019; Supachaipanichpong et al., 2018; Balducci et al., 2019; Johansen et al., 2017; Mohd et al., 2016), the studies were quantitative randomized with the target population being persons diagnosed with T2D. However, there are specific variations in these populations. For example, in both Whitehead et al. (2017) and Balducci et al. (2019), the persons had to have T2D for more than 12 months. Likewise, while for the other studies the sample population was engaged in controlling/managing the diabetes condition, in Supachaipanichpong et al. (2018), the sample population was persons with uncontrolled T2D.
A comparison of the limitations of the study
The limitations of the studies reviewed vary from the nature of the study and the design of the study. In the research by Costa et al. (2015) and Sapkota et al. (2015), a systematic literature review methodology is used, which is level 1 evidence, which is a limitation of the study. In the study by Balducci et al. (2019), several limitations have been discussed. First, the study sample was small and thus not representative of the population. This is in line with Costa et al. (2015) findings that most of the studies on behavior intervention to manage T2D target only the older generation. As a result of this limitation, the findings of the study and the intervention are not generalizable or implementable without further investigations by applying the intervention in diverse cohorts. The factors to consider in the cohorts include climate, socioeconomic status, and culture. Second, the study utilized an accelerometer which might have promoted participants in the standard care group to be physically active. Third, the accelerometer was not set to provide time-stamped data and thus not possible to get direct sedentary time data or establish a pattern of sedentary time. Lastly, the diet of the participants was not considered as a variable and it was not factored into data analysis. This is despite the fact that, participants received dietary prescriptions and whether they adhered to diet was being verified at intermediate nurse visits.
A conclusion section, incorporating recommendations for further research
In all the 8 studies, the conclusion is that adherence to medication is vital in the management of T2D. In addition, Sapkota et al. (2015) conclude that an ideal intervention should have specific and targeted strategies that can be tailored to meet each patient’s needs. However, depending on the design, the setting, and the study objective for each of the studies, there are various recommendations for future study. Costa et al (2015) recommend that future research should focus on the long-term efficacy of intervention tools on medication persistence as well as the role of formal and informal caregivers on patient adherence. Whitehead et al. (2017) recommend that additional research is required to explore the value of group sessions over individual interventions and the benefits of ACT compared to education. Guo et al. (2019) recommend that future research should include multiple sites, longer follow-up periods, and measurement of the burden on nursing staff. Supachaipanichpong et al. (2018) recommend that future research should focus on the effect of the intervention on blood glucose levels, different populations, and medication persistence. Balducci et al. (2019), as well as Johansen et al. (2017), recommend that future research needs to factor in diverse populations to increase the generalizability of the study findings.
References
Balducci, S., D’Errico, V., Haxhi, J., Sacchetti, M., Orlando, G., Cardelli, P., ... & Lucisano, G. (2019). Effect of a Behavioral Intervention Strategy on Sustained Change in Physical Activity and Sedentary Behavior in Patients With Type 2 Diabetes: The IDES_2 Randomized Clinical Trial. Jama, 321(9), 880-890.
Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., ... & Marengoni, A. (2015). Interventional tools to improve medication adherence: review of literature. Patient preference and adherence, 9, 1303.
Guo, Z., Liu, J., Zeng, H., He, G., Ren, X., & Guo, J. (2019). Feasibility and efficacy of nurse-led team management intervention for improving the self-management of type 2 diabetes patients in a Chinese community: a randomized controlled trial. Patient preference and adherence, 13, 1353.
Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., ... & Iepsen, U. W. (2017). Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Jama, 318(7), 637-646.
Mohd, M. M. A. H., Phung, H., Sun, J., & Morisky, D. E. (2016). Improving adherence to medication in adults with diabetes in the United Arab Emirates. BMC public health, 16(1), 857.
Sapkota, S., Brien, J. A., Greenfield, J., & Aslani, P. (2015). A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes—impact on adherence. PloS one, 10(2), e0118296.
Supachaipanichpong, P., Vatanasomboon, P., Tansakul, S., & Chumchuen, P. (2018). An Education Intervention for Medication Adherence in Uncontrolled Diabetes in Thailand. Pacific Rim International Journal of Nursing Research, 22(2), 144-155.
Whitehead, L. C., Crowe, M. T., Carter, J. D., Maskill, V. R., Carlyle, D., Bugge, C., & Frampton, C. M. (2017). A nurse?led education and cognitive behaviour therapy?based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial. Journal of evaluation in clinical practice, 23(4), 821-829.