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Overview
Diabetes is a state of glucose intolerance that requires the management of blood glucose. Evidence-based practice has been identified as a means of improving most areas of healthcare services (Fox, 2010). This approach is equally helpful in diabetes care. Abu-Gamar and Wilson (2007) examined evidence-based practice in diabetes care and made several findings. They pointed out that good glycemic control is important in reducing the incidence or severity of complications associated with diabetes. To make this approach more effective, they suggested that patients suffering from diabetes play a vital role in diabetes management. Glycemic control is a major intervention in the management of diabetes. Since diabetes is a state of glucose intolerance, management of the blood glucose level is necessary (Abu-Qamar & Wilson, 2007).
The emphasis on patient education (about the importance of glucose management) was made due to the realization that there was poor adherence of diabetic patients to treatments (An & Kim, 2012). An and Kim (2012) stated that over 56% of patients in Korea did not comply with diabetes control norms and glycemic control measures.
When the optimal blood glucose level is achieved, several complications related to diabetes are kept at bay. This finding has been supported by those from two main bodies – the UK Prospective Diabetes Study and the Diabetes Control and Complication Trial.
Summary Of Finding
Evidence suggests that glycemic control is an effective way of managing diabetes in adults. Good glycemic control ensures that the level of glucose in a diabetic patient is maintained at levels similar to that of a non-diabetic one. This way, the development of complications is delayed or eliminated. Pogach and Walder (2004) gave an example of hypertension as one of the complications related to diabetes. There are various ways the level of glucose in the blood can be managed. These include oral anti-diabetic drugs, exercise, adopting a healthy diet, and the use of insulin therapy.
Patients with type 1 diabetes require insulin replacement daily. This should mimic the insulin levels in a normal individual (non-diabetic).
As for type 2 diabetes, different treatment options should be provided. These include oral medication, exercise, and proper diet. Hailu, Mariam, Belachew, and Birhanu (2012, p. 2) also mentioned the importance of diet and exercise in the management of diabetes.
The emphasis on patient education (about the importance of glucose management) was made due to the realization that there was poor adherence of diabetic patients to treatments. It has been argued that diabetes is mainly a self-managed disease (An & Kim, 2012).
How to integrate into practice
One of the ways glucose levels are maintained at normal levels is through medication (Clissold1 & Clissold2, 2007). Medication is used to maintain the level of glucose in a diabetic patient to that similar to a non-diabetic one. When glucose is maintained at normal levels, the occurrence of complications associated with diabetes is reduced. Such complications include hypertension.
Diabetic patients, and those with type 1 diabetes, in particular, require being administered with replacement insulin daily. Insulin therapy involves providing artificial insulin that mimics the insulin that is produced by a healthy individual. Therefore, diabetic patients should be able to have normal biological functions
Patients with type 2 diabetes may receive oral medication in addition to exercising and having a proper diet. Diabetic patients should decrease the intake of foods that increase the glycemic index and ensure that they maintain a healthy weight.
Patient compliance to self-monitoring of blood glucose levels is required if treatment is to be effective.
Treatment cannot be effective if the patient does not comply with the treatment provided. It has been identified that depression is one of the factors that contributed to poor glycemic control. Approximately 30% of adult diabetic patients suffered from depression. However, nurses play a big role in motivating these patients. Patient education is an effective way of ensuring glycemic control in diabetic patients. It is important in empowering self-management behavior. In this regard, diabetic patients should be provided with information about the disease process, treatment options, possible complications, and the way self-monitoring of glucose levels is done.
Even though glycemic control is important in diabetes management, tight glycemic control may be harmful to certain individuals (Lee, Boscardin, Cenzer, Huang, Rice-Trumble, & Eng, 2011). The frail older adults, in particular, were thought to be vulnerable.
It is argued that the harmful effects of the intensive glycemic control measures outweighed the benefits. Pogach and Walder (2004, p. 85) agree with this view since they argued that such intense measures increased the incidence and severity of hypoglycemia.
Therefore, health practitioners should determine the proper intensity of glycemic control for individual patients to ensure that the treatment is beneficial and effective.
References
Abu-Qamar, M., & Wilson, A. (2007). Evidence-based decision-making: The case for diabetes care. Int J Evid Based Healthcare, 5(1), 254-260.
An, G., & Kim, Mi-Ja, K. (2012). Powerlessness, social support, and glycemic control in Korean adults with type 2 diabetes. Contemporary Nurse, 42(2), 272-279.
Clissold1, R., & Clissold2, S. (2007). Insulin glargine in the management of diabetes mellitus: An evidence-based assessment of its clinical efficacy and economic value. Core evidence, 2(2), 89-110.
Fox, A. (2010). Intensive diabetes management: Negotiating Evidence-based practice. Can J Diet Prac Res, 71(1), 62-68.
Hailu, E., Mariam, W., Belachew, T., & Birhanu, Z. (2012). Self-care practice and glycaemic control amongst adults with diabetes at the Jimma University Specialised Hospital in South-west Ethiopia: A cross-sectional study. Df. Afr J Prm Health Care Fam Med., 4(1), 1-6.
Lee, S., Boscardin, J., Cenzer, I., Huang, E., Rice-Trumble, K., & Eng, C. (2011). The risks and benefits of implementing glycemic control guidelines in frail older adults with diabetes mellitus. JAGS, 59(4), 666-672.
Pogach, L., & Walder, D. (2004). Development of evidence-based clinical practice guidelines for diabetes. Diabetes Care, 27(5), 82-89.
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