Essay Example on Critiquing Research on Type 2 Diabetes and Ethics

Introduction

A research critique appraises the strengths and limitations of an article. In the last week, the clinical issue discussed was type 2 diabetes. The PICOT question was: Do lifestyle changes for adult patients with type 2 diabetes who comply with nurse-led lifestyle changes (p & I) compared to those that do not (c) reduce HbA1c value within 6 months (o & t)? Furthermore, in research, ethics must be considered to protect participants from harm. The purpose of this paper is to write a critical appraisal that demonstrates the understanding of two quantitative articles which discuss the PICOT question. Also, the paper provides an analysis of the ethical considerations addressed in the two articles. There is a need for nurse-led interventions for effective management of type 2 diabetes.

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Background

Azami et al. (2018) affirmed that diabetes is a public health concern that causes complications and mortality. Due to that, the authors discussed the responsibility of nurses to inspire positive changes through self-management practices. The purpose and objective of the research were to discuss the way nurse-led education programs control the HbA1c values of patients with type 2 diabetes. The research question was whether self-management practices reduce HbA1c levels. Furthermore, Waller et al. (2019) affirmed that diabetes is a health burden. According to the author’s patients with diabetes do not meet optimum diabetes management. Due to that, the objective and purpose of the research were to discuss text message intervention that would improve self-management practices such as diet and physical activity to improve the HbA1c values of the patients. The research question was whether DTEXT intervention improves HbA1c values and self-management. Both articles are significant to nursing because they equip nurses with the knowledge on the way to incorporate modifiable lifestyle changes to reduce the blood sugars of patients living with diabetes.

How the two Articles Support the Nurse Practice Issue Chosen

The article by Azami et al. (2018) will be used to answer the PICOT question because it will provide more information on the effectiveness of nurse-led diabetes self-management education about glycosylated hemoglobin (HbA1c values). The article discusses preventive health-seeking behaviors such as diet, foot care, taking medication, monitoring blood glucose, and physical activity. Furthermore, the article by Waller et al. (2019) will be used to answer the PICOT question because it will provide more information on whether text messages will increase engagement in self-management behaviors in people living with diabetes.

The interventions and comparison groups in the articles compare to those in the PICOT question. The interventions and comparison group in the PICOT question are nurse-led lifestyle changes such as nutrition, exercises, and foot care to reduce the HbA1c values in patients with type 2 diabetes. The article by Azami et al. (2018), for example, discussed interventions such as diet, foot care, taking medication, monitoring blood glucose, and physical activity in patients with type 2 diabetes. Additionally, the article by Waller et al. (2019) discussed interventions such as diet and physical activity in type 2 diabetes.

Method of Study

Both articles incorporated a randomized control trial method. In the article by Azami et al. (2018), the authors randomized participants into two groups. The first was a control group (N=71) that gets usual diabetes care routines. The second was the intervention group (N=71) that receives usual diabetes care plus 24 weeks of nurse-led diabetes self-management education. Furthermore, according to Waller et al. (2018), the randomized control trial encompassed a control and parallel arm. The control arm (N=171) received usual care while the intervention arm (N=171) received 1-3 months of text message, usual care, and 4-6 months of messages four times per week. The methods used in each study are similar. The difference is the intervention used. In the first article by Azami et al., (2018), the randomized control trial used one on one nurse-led interaction with patients while the study by Waller et al., (2019) incorporated nurse-led text-message as an intervention.

The randomized control trial method has benefits and limitations. The benefit is that it makes the interpretation of statistical analysis easy. The limitation of the method is that it causes selection bias

Results of Study

In the article by Azami et al. (2018), findings showed that participants in the intervention group had lower HbA1c values compared to those in the control group. More so, the researchers noticed that changes in systolic blood pressure and diastolic blood pressure varied between the control and intervention groups because of differences in the participant’s body weight. Also, during the 24 weeks of nurse-led diabetes self-management education, researchers observed an increase in social support in the intervention group compared to the control group.

In the article by Waller et al. (2019), the researchers are unclear about the findings. However, as they indicated in the article, text message intervention has promising results for reducing the HbA1c values and enhance self-management behaviors in patients with type-2 diabetes. They indicated that the findings from the text message intervention is equitable among patients from different socio-economic backgrounds, and would improve their quality of life.

One of the implications of the two studies in nursing practice is that nurses will get more information on ways to promote healthy behaviors in patients with type 2 diabetes. Nurses can incorporate nurse-led diabetes self-management education programs such as diet, physical activity, monitoring blood glucose, and foot care, to improve the clinical and lifestyle behaviors of their patients. Additionally, through the use of text message reminders, nurses can improve the health outcomes of patients in the long-term.

Outcomes Comparison

The anticipated outcome of my PICOT question is that by the end of 6 months, patients with diabetes would have reduced HbA1c values. The outcomes of the chosen articles compare to my anticipated outcomes. In the article by Waller et al. (2019), for example, the researchers affirmed that by the end of their study, they know that the text message intervention will reduce the HbA1c values of the patients and improve their quality of life. More so, in the research by Azami et al. (2018), findings showed that nurse-led interventions improved the lifestyle behaviors of patients with type 2 diabetes.

Ethical Considerations

Both studies had ethical considerations. The first one is about ethical approval. The article by Azami et al. (2018) sought approval from the University Putra Malaysia Ethics Committee for Research Involving Human Subjects and Medical University of Ilam Ethics Committee. Additionally, the article by Waller et al. (2019) sought approval from the Joint University of Wollongong & Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee. Furthermore, in both studies, researchers conducted a risk-benefit ratio analysis to identify participants for the study. Another ethical consideration is regarding informed consent. In both studies, researchers obtained informed consent from participants before engaging in the studies. The fourth ethical consideration was the inclusion/exclusion criteria. In the research by Waller et al. (2019), researchers included patients who had type 2 diabetes and HbA1c values of 7% and above, could speak English and had mobile phones. They excluded pregnant patients to eliminate gestational diabetes. Furthermore, research by Azami et al. (2018) included participants who were Iranian, had a clinical diagnosis of type 2 diabetes for over six months and had HbA1c values above 8%. They excluded illiterate patients, those who were pregnant, had chronic complications, and had limited mobility.

References

Azami, G., Soh, K. L., Sazlina, S. G., Salmiah, M. S., Aazami, S., Mozafari, M., & Taghinejad, H. (2018). effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of diabetes research, 2018(4930157). https://doi.org/10.1155/2018/4930157

Waller, K., Furber, S., Bauman, A., Allman-Farinelli, M., Dolder, P., Hayes, A. … Colagiuri, S. (2019). DTEXT – text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis. BMC Public Health 19(262). https://doi.org/10.1186/s12889-019-6550-6