In PICOT format, clinical question
People with Type 2 Diabetes Mellitus: Intervention: Lifestyle and dietary modifications. Comparison: Standard Care without any dietary or lifestyle changes. Outcomes: Better glycemic control. Time: 3 Months
Opportunities or a Clinical Problem
T2DM (type 2 diabetes mellitus) is a significant public health issue worldwide. The prevalence rate for adults between 20 and 79 years old has been estimated at 10.5%. The disease is associated with high morbidity, mortality and expensive healthcare. T2DM can be prevented or delayed by controlling glycemic levels. This includes neuropathy and cardiovascular disease. T2DM management requires pharmacological intervention, but lifestyle and dietary changes are equally important to achieve optimal glycemic control. Many patients struggle to adhere to the guidelines, even though they are based on evidence. This can lead to poor control of blood sugar and an increased chance of complications. Effective nursing interventions are needed to encourage patients with T2DM to adhere to lifestyle and dietary modifications. This will improve glycemic control, and reduce the chance of complications.
Literature search and articles selection
Literature searches were conducted by using databases mentioned in Chapter 3 of Melnyk & Finout-Overholt (2015)’s textbook, which includes CINAHL and PubMed as well as the Cochrane Library. The following search terms were used: “type 2 diabetes mellitus,” “dietary modification,” “lifestyle modification,” “nursing interventions,” and “glycemic control.” The search was limited to articles published in the last five years and written in English.
After reviewing the abstracts and titles, we identified 44 articles. 16 of these articles fulfilled the inclusion criteria. Five research articles were chosen based on the relevance of their evidence to the clinical question. You can find a summary of the articles in Table 1.
Table 1: A Summary of Select Research Articles
| Article | Design | Sample | Intervention | Results | Niveau of evidence Better glycemic controls II Systematic review • Cohort Cross-sectional |
|---|
- | RCT | n=100 | Dietary and lifestyle modifications vs. standard care | Improved glycemic control | I
- | Quasi-experimental | n=80 | Group-based dietary and lifestyle education vs. individual education | Improved glycemic control | II
- | Systematic review | n=17 RCTs | Nurse-led lifestyle interventions vs. usual care | Improved glycemic control, weight loss, and quality of life | I
- | Cohort | n=300 | Nurse-led self-management education vs. physician-led education | Improved glycemic control and self-efficacy | II
- | Cross-sectional | n=500 | Nurse-led motivational interviewing vs. standard care | Improved adherence to dietary and lifestyle modifications | III
Wu et.al. have done a systematic review that supports the most effective nursing interventions in promoting lifestyle and dietary modifications for patients with T2DM. (2020). (2020). The purpose of the study was to compare nurse-led lifestyle interventions to improve glycemic control and weight loss in T2DM patients. This review included 17 randomised controlled studies (RCTs), which had a total 2175 participants. These interventions were dietary education and lifestyle, motivational interviewing, exercise promotion, self management support and physical activity promotion.
It was found that nursing-led lifestyle interventions were significantly better than traditional care for patients suffering from T2DM. These improvements were maintained over time and had moderate to large effect sizes. Authors