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Manage Discussion Entry Assignment
Manage Discussion Entry Assignment
I chose Case Study #3, about an 80-year-old former army officer with type 2 diabetes who had hypoglycemia while using insulin and OHAs.
The patient was reliant on an attendant to provide injections, which resulted in hypoglycemic episodes due to erratic insulin dose administration.
The patient was then started on Degludec insulin, and his HgBA1C and fasting blood sugar levels improved over time.
There were no more bouts of hypoglycemia in the patient (Kumar, 2015. p. 877).
In the PICO (T) format, I asked: Do older patients with Type 2 diabetes demonstrate improvement with bouts of hypoglycemia, FBS, and HgBA1C with Degludec?
PICOT is an abbreviation for parts of the clinical inquiry, according to (Stillwell et al, 2010. p. 59).
They are useful for summarizing research questions pertaining to the consequences of therapy (Riva et al, 2012. p. 168).
Patient population (P)
I-Intervention or topic of concern
C- Contrast between intervention and interest
O- Intervention or interest outcome
T- The amount of time it takes for an intervention to be effective.
Stillwell et al. (2010), p. 59
There are two types of clinical questions, background and foreground.
To evaluate which therapies are most helpful for patient outcomes, the foreground question appears to use questions asked in the PICOT framework.
Nursing research tries to investigate health-related phenomena, solve problems, evaluate ideas to enhance nursing care, and develop new information to advance our profession (CCN, 2017)
Using the PICOT format, here is my clinical question:
P- Patients over the age of 65 with type 2 diabetes
I’m taking Degludec and OHA’s.
C- Using normal insulin and OHAs
FBS and HgBA1C levels have improved, and there have been no more instances of hypoglycemia.
T- There was no time frame measured.
The focus of my query, “Is Degludec useful in improving hypoglycemia episodes?” would be on treatment prognosis.
Are patients experiencing fewer hypoglycemic episodes, and is disease control achieved with treatment?
According to the case study, once the patient began taking Degludec, there was an improvement in FBS and HgBA1C and no additional indications of hypoglycemia.
The therapeutic focus in patients with diabetes mellitus (DM) is on preventing hyperglycemia-related complications.
In the United States, 57.9% of diabetic patients have one or more diabetes-related problems, and 14.3% have three or more.
1
Strict glycemic control within established guideline levels is the major technique for preventing the onset and progression of numerous problems linked with diabetes’s microvascular consequences (eg, retinopathy, nephropathy, and neuropathy).
Treatment of dyslipidemia and hypertension is aggressive, with the goal of reducing the cardiovascular problems associated with macrovascular consequences.
Large, well-controlled trials have demonstrated the beneficial effects of proper glucose management on microvascular and macrovascular problems.
2-5
See Diabetes’s Macro- and Microvascular Effects for more information.
Glycemic Management
To assess a patient’s glycemic control, two basic approaches are used: self-monitoring of blood glucose (SMBG) and serum hemoglobin A1c testing (HbA1c).
Blood Glucose Self-Monitoring
By giving a real-time assessment of blood glucose, SMBG is a useful tool for evaluating short-term glycemic management.
It assists patients and physicians in determining the effects of food, drugs, stress, and activity on blood glucose levels and making necessary modifications.
Clinical trials have shown that SMBG plays a role in effective glycemic control for patients with type 1 diabetes or insulin-dependent type 2 diabetes because it helps patients refine and adjust insulin doses by monitoring for asymptomatic hypoglycemia as well as preprandial and postprandial hyperglycemia.
5-7
The frequency of SMBG is determined by the kind of medical therapy, the risk of hypoglycemia, and the requirement for short-term therapeutic adjustments.
According to current American Diabetes Association (ADA) standards, people with diabetes should self-monitor their glucose levels at least three times per day.
8
People who utilize basal-bolus regimens should self-monitor before each meal and before going to bed (4 times daily).
Some patients require more regular monitoring at first, including preprandial and postprandial measurements.
Patients with gestational diabetes who are receiving insulin should have their blood glucose levels checked three or more times per day.
Several businesses have recently created continuous glucose monitors that measure interstitial glucose levels, which have been demonstrated to improve glycemic control without raising the risk of hypoglycemia much.
9-10 Patients must still monitor their blood glucose levels twice a day in order for the gadget to be calibrated.
It is widely suggested that people with type 2 diabetes self-monitor their blood glucose levels, although the data to support this practice’s usefulness is equivocal.
Initial studies demonstrated that SMBG lowered HbA1c in type 2 DM patients, but the presence of health-improving habits, such as diet and exercise, in many of the analyses made determining the degree of impact of SMBG problematic.
2, 11 After 12 months, follow-up studies that controlled for this found no meaningful improvement in glycemic control.
12-13
References:
Chamberlain College of Nursing. (2017). Introduction to Evidence Based. Practice. Week 1 [Online lesson]. Downers Grove, IL DeVry. Retrieved from: https://chamberlain.instructure.com/courses/12226/pages/week-1-lesson?module_item_id=1191535
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