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Identifying Issues and Searching for Evidence

Contents

Introduction.

Research question.

Search strategy.

Literature review..

Introduction to Type-1 Diabetes Mellitus Analysis

Type-1 diabetes mellitus is an illness which is linked with the immune system of the body. In this,β cells of the body are destructed which produces insulin. In previous times, type-1 diabetes mellitus was mostly occurring in patients who were children or were teenagers but now this disease has no limiting age factor. In addition to this, patients also have polyuria, polydipsia and polyphagia. For this disease, insulin replacement is necessary from en exogenous source which is a lifelong treatment. Type-1 diabetes mellitus happen because of autoantibodies formation against islet cells (Atkinson, Eisenbarth and Michels 2014). Its prevalence in the world has increased continuously. In the United States of America only there are 34.2 million people who are suffering from this disease. This data suggests that Type-1 diabetes mellitus is in 1 person out of 10 (Centers for Disease Control and Prevention 2020). The diagnosis could be done if the fasting blood glucose is more than 7 mmol/L or the patients have signs of hyperglycemia (Atkinson, Eisenbarth and Michels 2014). The role of insulin is very crucial here. Self-monitoring could help with the management of the disease. Therefore, insulin could be given to the Type-1 diabetes mellitus patient 3-4 times in a day via an insulin pump or insulin injection (Kahanovitz, Slussand Russell 2017). Insulin pumps are a very easy way of delivering insulin inside the human body. It is small, adjustable, convenient and accurate (Aathiraand Jain 2014). Before this method, conventional insulin therapy was used by healthcare professionals. In this, insulin is provided by injection two times a day so as to balance the overall rate of glucose inside the body. The conventional method also includes self-checking of blood glucose level and urine with undertaking education about exercise and diet. These methods help in the supervising of Type-1 diabetes mellitus (Iqbal, Novodvorsky and Heller 2018).

Evidence-informed practices take healthcare professionals like nurses as critical thinkers and motivate them to gain knowledge about multiple types of research that are going on, for example, systematic review, qualitative research, mixed-method, quantitative research and randomized control trials). This approach also tells them to make use of this information in an integrated manner. It also regards the most relevant and best research which is available. Besides that, it states about the practice which is based on the hierarchy of the evidences. Thus, it helps in providing the best answer to the research question. This practice helps the nurse in evaluating the best material or evidence for the treatment of the patient (Kumah et al 2019).

This subject is very important to registered nurse because they can help patients with Type-1 diabetes mellitus. Nurses could provide them with a partnership in managing their disease and could tell them about the measures they can take in critical circumstances. They can also educate the patients with the most flexible treatment option and could help patients to control their blood glucose level. They can teach patients on how they can prevent and protect themselves from complications which are linked to Type-1 diabetes mellitus. Nurses could also help in managing acute complications which could be presented as ketoacidosis and hyperglycemia (Phillips 2016). In addition to that, nurses could also analyze the patient's critical troubles with the disease. They could also provide the patient with social and emotional support. Also, nurses could support a patient's family too and could also refer patients to other specialists so that they receive holistic care from every aspect (Vissarion, Malliarou, Theofilou and Zyga 2014).

Research Question

Therefore, the research could be done by taking patients of Type-1 diabetes mellitus as the pollution, insulin pump as the intervention, conventional insulin therapy as comparison and outcome as improvement in glycemic control and reducing the danger of hypoglycemia. Hence, the research question for the study will be the Effectiveness of an insulin pump in comparison to conventional insulin therapy to improve glycemic control and reducing the risk of hypoglycemia in Type-1 diabetes mellitus patients. PICO tool is effective and most reliable in making a research question and it also helps in identifying relevant evidence for making a review which is completely based on pieces of evidence (Methley et al 2014).

Search Strategy

Only those studies were chosen for this report which was published in the English language. Full-text papers were considered for writing the report. The database which was used for the report writing was Google Scholar and PubMed. Google Scholar is a database which helps in searching relevant literature for the researches. It provides the user with a single point where they can search about articles, books, court opinions, and theses, abstract from various sources such as professional societies, universities websites, and academic publishers and from other web sites also. Google Scholar helps people to find authentic work (Google scholar 2020). PubMed is a database which provides the user with the material free of cost. The resources also support the searches by retrieving life science and biomedical articles and literature. The aim of the database is to help in improving the health of people worldwide. PubMed also contains abstract and citation which is more than 30 million in numbers. PubMed in addition to this offers links which could provide researchers with full-text pieces of literature and articles. The content which is available on this database contains articles related to bioengineering, behavioural sciences, life sciences and chemical sciences (PubMed 2019).

In Google Scholar, the search was conducted by putting Effectiveness of insulin pump in comparison to conventional insulin therapy to improve glycemic control and reducing the risk of hypoglycemia in Type-1 diabetes mellitus patients into the search tab and year constraints were also used while doing the search. This was done so that only recent studies could be used for making the report. Other keywords were used which was conventional insulin therapy compared with the insulin pump. For searching in PubMed, different keywords were used. They were:

Population

Intervention

Comparator

Outcome

Type-1 diabetes mellitus patients

Insulin pump

Conventional insulin therapy

To improve glycemic control and reducing the risk of hypoglycemia

Diseased people suffering from Type-1 diabetes mellitus

Insulin pump therapy

Multiple daily injections

Advances in eliminating the danger of hypoglycemia and in glycemic control

Boolean operators were used as an effective strategy to find relevant articles with the help of key words combination (Grewal, Kataria and Dhawan 2016). First, the search terms were used with AND operator. It was used like this: Type-1 diabetes mellitus patients AND Insulin pump AND Conventional insulin therapy AND To improve glycemic control and reducing the risk of hypoglycaemia. Then the OR operator was also used with the same keywords. It was like this: Type-1 diabetes mellitus patients OR Insulin pump AND Conventional insulin therapy AND To improve glycemic control and reducing the risk of hypoglycaemia. After two searches, synonyms were used to search the paper. They were used as diseased people suffering from Type-1 diabetes mellitus AND Insulin pump therapy AND Multiple daily injections AND Advances in eliminating the danger of hypoglycemia and in glycemic control. Then after this, the OR operator was used with the same keywords. Diseased people suffering from Type-1 diabetes mellitus OR Insulin pump therapy AND Multiple daily injections AND Advances in eliminating the danger of hypoglycemia and in glycemic control.

When the research question was searched in Google scholar, it provided 5,800 results and when conventional insulin therapy comparison with insulin pump was searched, it showed 57,700 articles. The PubMed showed 20 pieces of literature and articles that were relevant to the study.

Literature Review of Type-1 Diabetes Mellitus Analysis

The research conducted by Joshi and Choudhary have talked treating patient of Type-1 diabetes mellitus and have compared using of insulin pump therapy and multiple injections on the daily basis by the patients (Joshi and Choudhary 2015). They have focused on these interventions so as to optimise the control of the glucose in patients and to reduce hypoglycaemia. They have shown that both the strategies can be used for the treatment of disease. However, by conventional therapy, researchers stated that some patients were not able to gain their targets of glucose. They also highlighted the fact that the intervention which was an insulin pump was very much beneficial for the patients. They also mentioned that an insulin pump helps in controlling and reducing hypoglycaemia whereas the conventional method could not show much effect. They discussed that patients suffering from Type-1 diabetes mellitus chosen insulin pump for their glucose control instead of the conventional method. This article is relevant to the question of the report as it answers what is more efficient in reducing hypoglycaemia and improving glycemic control. It clearly outlines that the insulin pump is more affected for both the problems (Joshi and Choudhary 2015). Level of evidence of this literature is high because it is a critically-appraised topic.

The research conducted by Alamoudi and his colleagues aims to compare the profiles of the glucose of the patients suffering from Type-1 diabetes mellitus who have used insulin pump and conventional insulin delivery by injections for a longer period of timeAlamoudi et al 2017). They have assessed the outcome of hypoglycaemia rates. Other results were of glycemic control. Their research highlighted that there were not many differences in Type-1 diabetes mellitus patients and in their rates of hypoglycaemia that used two different methods for the intake of insulin. However, the study shows that insulin pump was linked to the low amount of variability of glucose. This paper was relevant to our research question because it talks about how the two methods that are in comparison affect the patients of Type-1 diabetes mellitus. They are almost the same in controlling the signs and symptoms of hypoglycaemia but the insulin pump method reduced the variability of glucose in the blood (Alamoudi et al 2017). The level of evidence for this study is low because it is a cohort study.

The research conducted by Little and his colleagues have the objective to find out the awareness of hypoglycemia in Type-1 diabetes mellitus patients (Little et al 2014). They have compared various methods which can help in the self-control of the disease. They are insulin infusion by the pump and regular injections to control and monitor the glucose level. Their results stated that conventional intake of insulin and by the pump has similar effects on the patient and on their hypoglycaemia whereas the insulin pump provides more satisfaction to patients who are suffering from Type-1 diabetes mellitus. Thus, this paper is relevant to this study as it compares the two methods and also stated that an insulin pump is a more comfortable option for Type-1 diabetes mellitus patient. However, this method does not have an advantage over the conventional method but the process of intake of the insulin has been made easy by it. Therefore, Insulin pump could be used for glycemic control and for also reducing the danger of hypoglycaemia in patients of Type-1 diabetes mellitus (Little et al 2014). This study is a randomized controlled trial and thus, provides a low level of evidence.

The objective of the study performed by Karges and his colleagues was to identify the number of chronic cases of diabetic ketoacidosis and hypoglycemia when it is compared between two methods which are insulin injection which was a conventional method and another one was by pump therapy in young patients who are suffering from Type-1 diabetes mellitus (Karges et al 2017). It was found out the young patients were at lower risk of hypoglycaemia when they were given insulin by insulin pump therapy. They were also at a lower level of danger from ketoacidosis. The kids in addition also had more glycemic control during the therapy. Thus, the researchers stated that insulin pumps were far better than the intake of insulin via injections. This paper was relevant to our study because it clearly states that insulin pump therapy is much useful than conventional therapy and children were benefited in terms of glycemic control and the risk level of hypoglycaemia was also found to be less (Karges et al 2017). This study was a population-based cohort study and hence, has a low level of evidences.

In conclusion, it can be said that using of insulin pump instead of conventional method which consists of taking injections 2-3 times a day is a better option for patients suffering from Type-1 diabetes mellitus. The patients could have better glycemic control also and thus their risk towards hypoglycaemia can also be reduced. In addition, insulin pump therapy is a far comfortable option for the patients as the device is very small and convenient to use. The paper that is reviewed in the reports also claimed similar results. Type-1 diabetes mellitus could affect the way of living of a patient and thus nurses could help these diseased individuals with their problems by giving them social and emotional support and also by educating them and their families on the same topic.

References for Type-1 Diabetes Mellitus Analysis

Aathira, R., and Jain, V. 2014.Advances in management of type 1 diabetes mellitus. World Journal of Diabetesvol.5, issue.5, pp.689–696. https://doi.org/10.4239/wjd.v5.i5.689

Alamoudi, R., Alsubaiee, M., Alqarni, A., Saleh, Y., Aljaser, S., Salam, A. and Eledrisi, M., 2017. Comparison of insulin pump therapy and multiple daily injections insulin regimen in patients with type 1 diabetes during Ramadan fasting. Diabetes Technology & Therapeuticsvol.19, issue.6, pp.349-354.

Atkinson, M. A., Eisenbarth, G. S., and Michels, A. W. 2014.Type 1 diabetes. Lancet (London, England)vol383, issue.9911, pp.69–82.https://doi.org/10.1016/S0140-6736(13)60591-7

Centers for Disease Control and Prevention. 2020. National Diabetes Statistics Report, 2020. Retrieved from https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html [Accessed on 11 September 2020]

Google scholar. 2020. About. Retrieved from https://scholar.google.co.in/intl/en/scholar/about.html [Accessed on 1 September 2020]

Iqbal, A., Novodvorsky, P., and Heller, S. R. 2018. Recent updates on type 1 diabetes mellitus management for clinicians. Diabetes & Metabolism Journalvol.42, issue.1, pp.3–18. https://doi.org/10.4093/dmj.2018.42.1.3

Joshi, M. and Choudhary, P., 2015. Multiple daily injections OR insulin pump therapy: Choosing the best option for your patient—An evidence-based approach. Current Diabetes Reportsvol.15, issue.10, pp.81.

Kahanovitz, L., Sluss, P. M., and Russell, S. J. 2017. Type 1 Diabetes - A Clinical Perspective. Point of Carevol.16, vol.1, pp.37–40.https://doi.org/10.1097/POC.0000000000000125

Karges, B., Schwandt, A., Heidtmann, B., Kordonouri, O., Binder, E., Schierloh, U., Boettcher, C., Kapellen, T., Rosenbauer, J., &Holl, R. W. (2017).Association of insulin pump therapy vsinsulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA318(14), 1358–1366. https://doi.org/10.1001/jama.2017.13994

Kumah, E.A., McSherry, R., Bettany‐Saltikov, J., Hamilton, S., Hogg, J., Whittaker, V. and van Schaik, P., 2019. PROTOCOL: Evidence‐informed practice versus evidence‐based practice educational interventions for improving knowledge, attitudes, understanding, and behavior toward the application of evidence into practice: A comprehensive systematic review of undergraduate students. Campbell Systematic Reviewsvol.15, issue.1-2, p.e1015.

Little, S.A., Leelarathna, L., Walkinshaw, E., Tan, H.K., Chapple, O., Lubina-Solomon, A., Chadwick, T.J., Barendse, S., Stocken, D.D., Brennand, C. and Marshall, S.M., 2014. Recovery of hypoglycemia awareness in long-standing type 1 diabetes: A multicenter 2× 2 factorial randomized controlled trial comparing insulin pump with multiple daily injections and continuous with conventional glucose self-monitoring (HypoCOMPaSS). Diabetes Carevol.37, issue.8, pp.2114-2122.

Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R. and Cheraghi-Sohi, S. 2014. PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Researchvol.14, issue.1, pp.579.

Phillips, A., 2016. Supporting patients with type 1 diabetes. British Journal of Nursingvol.25, issue.6, pp.330-334.

PubMed. 2019. PubMed overview. Retrieved from https://www.nlm.nih.gov/bsd/pubmed.html#:~:text=PubMed%20is%20a%20free%20resource,of%20peer%2Dreviewed%20biomedical%20literature [Accessed on 1 September 2020]

Vissarion, B., Malliarou, M., Theofilou, P., &Zyga, S. 2014. Improvement of diabetic patients nursing care by the development of educational programs. Health Psychology Researchvol.2, issue.1, pp. 931. https://doi.org/10.4081/hpr.2014.931

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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