Title : Literature review in T2DM in geriatrics population
Abstract:
INTRODUCTION
- The study addresses the effect of exercise and diet on type 2 diabetes (T2DM).
- An estimated 37.3 million Americans have diabetes, with 1.4 million incidence in 2019 (CDC, 2023).
- The total cost of treating and managing T2DM is $327 billon annually (CDC, 2023).
- The study assesses the efficacy of combined therapy compared to pharmacotherapy alone in managing T2DM.
RESEARCH PROBLEM
- T2DM adversely affects patient quality of life.
- The condition leads to other comorbidities, including obesity and hypertension (Soleimani et al., 2020).
- Increasing prevalence and incidence, despite current pharmacotherapeutic interventions.
- There is a need for more research to establish evidence-based and holistic approaches to T2DM management.
RESEARCH PURPOSE
- As highlighted, T2DM’s incidence is on the increase, with 1.4 new cases in 2019 alone (CDC, 2023).
- High annual treatment and management costs.
- Reduced quality of life for affected persons.
- Persons older than 60 years at more risk of T2DM and its complications.
- Developing more effective therapies for T2DM is vital in enhancing the quality of life of those affected.
- PICOT: In a population of adults aged 60 years and over (P), what is the effect of a combination of physical activity and improved diet, and pharmacotherapy (I) in comparison to pharmacotherapy alone (C) in the management of type II diabetes (O) over six months (T)?
METHODOLOGY
- A critical appraisal and systematic review of quantitative studies.
- Three databases, including PubMed, Cochrane Library, and Excerpta Medical Database (EMBASE) used.
- Keywords, such as physical activity. Dieting, and pharmacotherapy used.
- Boolean operators applied to narrow to the most appropriate sources from the database.
- Inclusion criteria: Studies in English, published between 2019 and 2023, and including randomized controlled trials.
- 1187 studies initially found and narrowed to 83 after applying the limiters.
- The abstracts of the 83 studies skimmed to confirm their quality.
- 12 studies selected for the synthesis of literature.
SYNTHESIS OF THE LITERATURE
- Betty Neuman's System Model guides this work which emphasizes the need for holistic care to address the different causes of disease and ensure patient satisfaction.
- Physical activity and diet effective in reducing blood glucose levels.
- Resistance training improved quality of life scores from 22.58 to 27.52 (p= 0.001) (Soleimani et al., 2020; Teo et al., 2020; Terauchi et al., 2022).
- Pharmacotherapy alone did not reduce blood glucose levels.
- Metformin and insulin combined with diets and exercise reduced blood glucose, high-density lipoprotein cholesterol, and high-sensitivity c-reactive protein (Arguello et al., 2020; Jalilvand et al., 2020; Rosenberg, 2021).
- Exercise, diet, and medication reduced glycemic levels from -0.61 to -0.28 at 95% CI (Terauchi et al., 2021; Van de Velde et al., 2021; Weber et al., 2022).
- Combination therapy improves quality of life.
DISCUSSION
- Combined therapy more effective than pharmacotherapy alone in managing T2DM.
- Low calorie diet and physical activity effective in reducing body weight and blood glucose (Soleimani et al., 2019; Jalilvand et al., 2020; Rosenberg, 2021).
- Insulin and metformin lead to adverse side effects when used alone in the long-term.
- Gaps in precise prescription of combined therapy may adversely affect efficacy.
IMPLICATIONS FOR NURSING PRACTICE
- Combined therapy effectively manages T2DM.
- The evidence can be translated into practice through interprofessional collaboration.
- Advocacy for policies and care protocols supporting holistic care.
- Inter-disciplinary collaboration to support care continuity and enhance patient outcomes.
RECOMMENDATIONS FOR FUTURE RESEARCH
- Future research should address the gaps in safety due lack of precise prescription.
- More emphasis on exercise duration and intensity, and type of foods.
- Examining possible contraindications and side effects.
