Glycemic Control in Diabetes

Glycemic Control in Diabetic by Adding Peer Support 

Glycemic control remains one of the most delicate balance to be achieved by a diabetic patient. The patient is required to maintain euglycemic levels of glucose in the blood, which is a target that needs many considerations. The knowledge to handle this condition requires education, strategies of decision-making, as well as adequate knowledge that enable one to avoid both hyper and hypoglycemia.

Maintaining of glucose levels is an objective that is sometimes managed by an individual person. However, in other cases, peer coaching may help better the situation with ease (Thom et al., 2013). Being a common disorder in the US, there has to be effective strategies to control its prevalence. This essay looks at whether peer support in combination with self-management can help improve glycerol control as opposed to when self-management education is used solely.

The Spirit of Inquiry Ignited

Just whom do patients with type 2 diabetes turn to once they are confirmed to have the condition? Putting yourself in a position of such a patient, would you find it easier to try and manage the condition alone or would you find it better to involve peers? What of relying on peers alone? (a rare one isn’t it!). All these questions form the basis of this work.  Evidence-based practices have to form the foundation of any arguments within this section. It is another question for a patient to understand the condition he/she is in but an entirely different one to be so sure of how the condition will be approached with success.

It is important to underscore the fact that the ultimate goal of methods to be used is to improve glycemic control among diabetic patients within a span of 12 to 24 months. The effectiveness of the method may be not being based on one that uses little time but also on one that is most effective and assures the safety of the diabetic patients.

But why type II diabetes? Statistically, according to the National diabetes statistics report of 2017, close to 30.3M people in the U.S. have diabetes (CDC, 2017).  This implies that approximately 9% of the U.S. population is living with diabetes. In addition, 1 in every 10 people in the US have diabetes or have been diagnosed for the same. More surprising, another 84.1M people are suffering from prediabetes, a health condition that led to type II diabetes if not treated within five years (CDC, 2017).

Even though this prevalence rates are high among the elderly population, questions still arise as to why the children being diagnosed with the same is increasing at an alarming rate.  With the shocking revelation that such numbers are bound to increase if people don’t observe their lifestyle, it evident that research have to be conducted to unearth the specific ways through which such conditions can be reduced if not eliminated completely.

Diabetes continues to be one the leading causes of death in the U.S. and it is a growing health problem that calls for immediate intervention (Liu et al., 2015). The question that one asks is whether the available mechanisms meant to control the levels of glycerol really work or not. To be specific, should one go for self-management education practice alone or should they combine with peer support to improve efficiency.

The PICOT Question Formulated

(P) Patients with type 2 diabetes

(I) Peer support added to current standard

(C) Compared to standard self-management education alone without Peer support

(O) Improve glycemic control

(T) 12 to 24 months

Type 2 diabetes continues to be a common health concern not only in the U.S. but across the globe. Evidence-based research show how self-management education has been utilized in improving glycemic control. Most patients have been trained on how to make many self-management decisions as well as engage in complex activities. The self-management and education programs has for a long time acted as a baseline upon which type two diabetic patients navigate through the many decisions they have to make in order to improve their health outcomes (Bullard et al., 2018).

DMSE helps facilitate knowledge, skill and the ability that makes self-care possible. However, there reaches a point that this education programs fail and hence call for help from peers.  As Thom et al. (2013) noted, effective self-management may be short lived and hence calling for the help of peers to provide the kind of ongoing support particularly needed to sustain the already instituted self-management practices (Thom et al., 2013). Some of the important functions of peer support include daily management support, social and emotional support, providing linkages to clinical care and also general availability which is very necessary for any type 2 diabetic patient.

So the question is, now that the two mechanisms seem to be both important for the patient to manage the condition, is self-management self-sufficient and does the combination of the two make matters better for a type 2 diabetic patient? The efficiency of the two can only be identified in comparison of their abilities to improve glycemic control based on specific time frames. The best option would definitely be based on the one that better improves glycemic levels with the quality care being guaranteed for the patient. It ought to also achieve this mandate within a specific time frame so as to guarantee the patient total safety. Glycemic control being a delicate balance to achieve, the mechanism to be employed has to be achieved within short time frame.

Having analyzed all these scenarios, it makes the PICOT question very easy to formulate. The identified population is patients with type II diabetes, the identified intervention is whether peer support in combination with self-management would be more effective as compared to only using the standard state of the art self-management, the comparison is without involving peer support. The intended outcome is to ensure improved glycemic control and the time frame is between 12 to 24 months.

Search Strategy Conducted

In this context, search strategy refers to the different methods used to identify literature about the PICOT question in mind. The search strategy will be developed by breaking down the review questions so as to help provide an effective search terms (Jarvis, Skinner, Carey & Davies, 2010). The PICOT structure is in itself an effective way through which the search terms can be identified so that they can provide a guide of how to review the literature. The concepts that are clearly defined in the PICOT question will also be used in the search engine. Database searches will be used based on the key words that appear in my POCIT question. Since the research question has already been formulated, the research strategy can be identified easily.

The research for the PICOT question in this case has been identified from primary sources such as: policy documents, books, systematic reviews, research reports, journal articles among others. Other primary sources include PubMed/Medline, NCBI database, CDC and WHO websites, American journal of medicine, BMC medicine, and The Cochrane Library among others.

Critical Appraisal of the Evidence

Article by Patil et al. (2016) gives an overview of peer support models that can help improve diabetes self-management and clinical outcomes. The author argues that the success of diabetic therapeutic programs relies on the ability of patient to effectively embrace self-management programs. Such programs include taking prescribed medicine in time, maintaining exercise regimes, following a strict recommended diet, coping with emotional needs among other general rigors one has to live with (Patil et al., 2016). The authors argue that despite all these requirements, patients have little knowledge on how to manage type II diabetes. The views of the author imply that self-management alone cannot provide required outcomes. There is very high need that support from peers comes in handy to help improve outcomes.

Peer support has also the advantage of providing and receiving social support that is important for the well-being of the patient. Support from someone that has experimental knowledge concerning a certain behavior can help reduce many problems (Patil et al., 2016). It is easy for a type two diabetic patient to learn how to achieve blood glucose monitoring by learning from those that have been in a similar situation before. What most scholars argue is that peer support is like group therapy and mutual support which are essential in improving psychological outcomes (Deng et al., 2016).

The methodology used in all these research articles is clearly convincing. Most of the research papers that support peer intervention in combination with self-management have set their methodology as a comparative analysis of many other articles that have documented comparative studies as well. The articles have shown that Telephone based peer support, community health workers, peer coaches, and many other kinds of peer support can be very effective if combined with self-management approaches (Deng et al., 2016).

Evidence Integration

Clinical expertise and patient preference are of the idea that improving glycerol control can be better achieved when peer support is integrated in self-management other than relying on self-management alone. For example, article by Deng et al. (2016) gives this comparative analysis based on rural communities of central China as a case study. The region has a patient to doctor ratio of 1000:0.6 making quality care almost a toll order to be achieved. With the increment in the number of diabetic patients in such regions, the authors argue that self-management education programs may not completely solve the problems of type 2 diabetes (Deng et al., 2016).

Being a chronic disease, meeting the challenges that come with type II diabetes can be costly to the hospital and healthcare providers. The problem is to provide patients with appropriate skills as a way of managing diabetes. The used studies argue that though self-management is important, it may not be self-sufficient in meeting the many challenges of this chronic illness. These arguments have also been given by Kapur and Harries (2013) by using a similar matrix in their article.

Self-management requires patients to access resources provided by health professionals as well as support for the maintenance of a healthy practice. Low cost strategies have to be implemented as a way of empowering these patients (Philis-Tsimikas et al., 2011). One of such a strategy is to use peer support and coaching.

Patient preference has also been an issue for debate when it comes to the improvement of glycemic control for patients who have type 2 diabetes. Kadirvelu and Sivalal Sadasivan (2012) have critically looked at the views presented by patients who have type 2 diabetes when it comes to embracing either self-management or peer support in helping improve glycerol control (Kadirvelu & Sivalal Sadasivan, 2012). In the article, patients were of the idea that self-management is good as it helps them promote independence, sense of responsibility as well as taking charge of their own conditions. However, most of them argued that this method needs a lot of resources as well as a lot of education programs that most of them had no opportunity to attend. Therefore. self-management cannot be independently used to improve glycerol control, instead it calls for peer support for it to be effective (Aswathy, Unnikrishnan, Kalra & Leelamoni, 2013). Furthermore, peer support makes it easy for patients with type 2 diabetes to gain enough educational programs with less stress.

Outcomes

Based on the articles cited in this essay, it is indeed possible to improve the control of glycerol in a patient suffering from type 2 diabetes. Whether by using either self-management techniques or a combination of self-management and peer support. However, it has also been shown that a combination of peer coaching and self-management is the surest way through which improvement of glycerol control can be achieved within the desired time.

Project Dissemination

It is evident that type 2 diabetes continue to be a global health problem due to increased cases of obesity, sedentary lifestyle, and unhealthy eating habits. It is no longer a chronic illness for developed countries since it continues to gain presence even in developing Nations. With the increase in deaths associated with the chronic illness, it makes it necessary for the local and national authorities to formulate appropriate strategies that can help control glycerol levels in a patient (Philis-Tsimikas et al., 2011). Some of those strategies have already found application in many countries yet the condition continues to cause a scare.

The findings obtained for this project are important to many stakeholders who rely on evidence-based research to make informed medical decisions. The debate on whether self-management can be used alone and help sustain the life of a type 2 diabetic patient as compared to combining self-management with peer support has been covered in detail. The opinion of the articles collected and the views of individual patients have shown that peer support combined with self-management practices can be more effective in controlling the amount of glucose levels in the patient who have diabetes. Therefore, this essay has sought to raise awareness that there is need for many peer support programs to be embraced in all countries as a way of managing glycerol levels in a type 2 diabetic patient.

Conclusion

The essay has shown that peer/community support in combination to self-management is a very likely candidate for community based management programs as a way of tackling type 2 diabetes. The advantage of peer review ranges from being a low cost intervention, they empower patients with skills that can be found easily and without necessarily seeking for the help of medical practitioners. The mechanism may not be resource engaging as has been shown in the various literature review articles given in the essay.

References

Aswathy, S., Unnikrishnan, A. G., Kalra, S., & Leelamoni, K. (2013). Peer support as a strategy for effective management of diabetes in India. Indian journal of endocrinology and metabolism, 17(1), 5. doi: 10.4103/2230-8210.107790

Deng, K., Ren, Y., Luo, Z., Du, K., Zhang, X., & Zhang, Q. (2016). Peer support training improved the glycemic control, insulin management, and diabetic behaviors of patients with type 2 diabetes in rural communities of central China: a randomized controlled trial. Medical science monitor: international medical journal of experimental and clinical research, 22, 267. doi: 10.12659/MSM.895593

Jarvis, J., Skinner, T. C., Carey, M. E., & Davies, M. J. (2010). How can structured self‐management patient education improve outcomes in people with type 2 diabetes? Diabetes, Obesity and Metabolism, 12(1), 12-19.

Kadirvelu, A., & Sivalal Sadasivan, S. H. N. (2012). Social support in type II diabetes care: a case of too little, too late. Diabetes, metabolic syndrome and obesity: targets and therapy, 5, 407. doi: 10.2147/DMSO.S37183

Kapur, A., & Harries, A. D. (2013). The double burden of diabetes and tuberculosis–public health implications. Diabetes research and clinical practice, 101(1), 10-19.

Liu, Y., Han, Y., Shi, J., Li, R., Li, S., Jin, N., … & Guo, H. (2015). Effect of peer education on self‐management and psychological status in type 2 diabetes patients with emotional disorders. Journal of diabetes investigation, 6(4), 479-486. doi: 10.1111/jdi.12311

Patil, S. J., Ruppar, T., Koopman, R. J., Lindbloom, E. J., Elliott, S. G., Mehr, D. R., & Conn, V. S. (2016). Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes. The Annals of Family Medicine, 14(6), 540-551. doi: 10.1370/afm.1982

Philis-Tsimikas, A., Fortmann, A., Lleva-Ocana, L., Walker, C., & Gallo, L. C. (2011). Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: a Project Dulce promotora randomized trial. Diabetes care, DC_102081. doi: 10.2337/dc10-2081

The Centers for Disease Control and Prevention (CDC), (2017). New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Thom, D. H., Ghorob, A., Hessler, D., De Vore, D., Chen, E., & Bodenheimer, T. A. (2013). Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. The Annals of Family Medicine, 11(2), 137-144. doi: 10.1370/afm.1443