In the medical field, there are constant inventions that are intended to improve the quality of care for patients. These interventions are based on qualitative and quantitative research whose results indicate the effectiveness of the practice on different patients. Patients living with medical conditions like Diabetes rely on these practices to make their lives better. The adoption of the interventions is based on how well the medical professions understand it and how it changes the lives of their patients. The following is a detailed look at one of the practices and how I would ensure its adoption in a medical setting.
Summary
There are so many problems related to diabetes mellitus type II. As such, different researches have been performed on the patients suffering from the disease to determine the effects of the variant A1C on the patients. The effects of the disease among the elderly patients have been seen to range from faulty A1C results to stress, to depression, and disease complications. The application of qualitative and quantitative research methods were used to come up with a clear picture of the effects of the disease as well as the different therapies proposed for adoption. The quantitative research provided insights to the observed situations and analyzing the perspectives and opinions of the participants. The approach was used to ensure that the information collected had a first person perspective in the interpretation of how to deal with the chronic disease. It also provides insight on how caregivers can improve the preventive care strategies. In the study, incretin-based therapy is proposed as a nursing practice. Incretin-based therapy is an efficient nursing practice compared to other medications that were developed earlier. For instance, sitagliptin is tolerated by the elderly patients since it has no side effects like vomiting or nausea due to its endogenous levels being intact GLP-1. It is achieved by using DPP-4i inhibition set at the upper physiological range limit. On the other hand, DPP-4i therapy has no association to weight loss or gastric emptying inhibition. Additionally, the use of the long-acting GLP-1R agonists helps in better control of glycaemia since there is a longer sustenance of GLP-1R activation. The research gives more details on diabetes mellitus, its effects, and the use of incretin-based therapies to treat the disease.
PICOT Question and its Significance to Practice
What are the effects of Low A1C and hypoglycemia in elderly patients? Over time, there has been an increase in the concern of type II diabetes mellitus among the elderly people. The disease increases the risk of premature death, disabilities, and the rise of other coexisting illnesses. Insulin resistance, inactivity, obesity, vascular complications, medications, and lifestyles are among the factors that result in the high risk of hypoglycemia in the elderly patients. There is a need for medical practitioners to look into the illness as it results in numerous financial burdens to all the stakeholders. They should also help the patients to understand that the illness is best addressed when they take up an individualized role in controlling the disease. Nurses must ensure the safety of the patients and uphold the quality of care as is in the national standards. As such, there will be a great reduction in the complications and incidences of hypoglycemia episodes.
Summary of the Articles
There are different problems related to diabetes mellitus type II. Various researches have been performed on the patients suffering from the disease to determine the effects of the variant A1C on the patients. The effects have been seen to range from faulty A1C results to stress, depression, and disease complication. It is important for nurses to note that glycated hemoglobin, which indicates the glucose levels in diabetes mellitus, could present inaccurate levels of HBA1c in a patient (Hara et al., 2014). Nurses must also be aware of the effects of dapsone on the A1C test and, therefore, should investigate if the patient had used dapsone to prevent the negative effects. Before concluding on the A1C levels in a patient, practitioners must also ensure that the diet of the patient is balanced since vegetables have been proved to reduce the HBA1c levels in a patient. Diabetes mellitus type II has greater effects on the elderly. Due to low HBA1c, the mortalities have also increased due to malnutrition, functional reduction, and malnutrition. The disease has been found to shift toward old age since close to 50% of the affected people were over 65 years of age. Hypoglycemia also affects the attendance of elderly patients to hospitals where 2.7 % of non-diabetic patients and 9.5% of all the diabetic patients had experienced an emergency hypoglycemia condition (Hara et al., 2014). Low HBA1c affects diabetes mellitus patients due to several factors such as treatment burden, stress, depression, and other new associated diseases. The above facts were proved using the different quantitative and qualitative research methods to ensure a balanced and all rounded approach toward the disease’s effects as discussed below (Huang, Liu, Moffet, John, & Karter, 2011).
Qualitative research provided insights to the observed situations and analyzing the perspectives and opinions of the participants. The approach ensures that the information collected has a first person perspective to interpret how they deal with the chronic diseases. It also provides insight on how caregivers can improve the preventive care strategies (Huang et al., 2011). The opinions from members of the family also increase empathy and awareness among the staff while taking care of the patients. On the other hand, the quantitative approach in this research facilitated the generation of results for a bigger population. The research method randomizes the collected data, thereby decreasing the possibility of interpretation bias. However, while quantitative research provides more participants as compared to qualitative research, the latter provides a deeper comprehension of the event since the data collected entails the attitudes and feelings of the participants (Chew, Sherina, & Hassan, 2015). When the two methods are conducted with upheld credibility, reliability, and ethical standards, they bring out a reality and also ensure sustained insight in improving the quality of patient care and the outcomes of the nursing practices as discussed in the nursing practice below.
Incretin-Based Therapy as a Nursing Practice
Despite the ability of diabetes mellitus type II patients being able to hit the A1C levels, there are some patients that still fall below the expected treatment goals. As a result, they fall at a high risk of developing complications associated with diabetes. As such, practitioners need to adopt nursing practices that will help the patients (Maryland & Gonzalez, 2012). For instance, incretin-based therapy could be adopted to offer the recently approved therapeutic agents to treat diabetes mellitus type II. The agents include GLP-1R and DPP-4i (glucagon-like peptide-1 receptor and dipeptidyl peptidase-4 inhibitors) (Abdelhafiz & Sinclair, 2015). The two agents, when used in therapies for diabetes patients, help in potentiating the signaling of the incretin receptor. Incretins are hormones derived from the gut. Basically, glucose-dependent insulinotropic peptide and glucagon-like peptide-1 are secreted in low quantities when the body is in the fasting state. As a result, the levels of circulation increase quickly when food is ingested. In the U.S., exendin-4 was approved to treat type II diabetes and is a GLP-1R agonist, related to the gut peptide (Abdelhafiz & Sinclair, 2015). Exendin-4 is administered through subcutaneous injection twice a day. Another GLP-1R agonist is liraglutide, which binds itself to albumin non-covalently. Its use in the treatment of diabetes has been approved in Europe. The use of sitagliptin, a DPP-4iderivative was also approved in the United States. It functions by using glucoregulatory actions, thereby preventing the degradation of incretin (Maryland & Gonzalez, 2012). As such, it potentiates GIP and GLP-1 action. It is administered as a tablet daily.
Efficiency of Incretin-Based Therapy
Incretin-based therapy is an efficient nursing practice compared to other medications developed earlier. For instance, sitagliptin is tolerated by the elderly patients since it has no side effects because its endogenous levels are intact GLP-1. It is achieved by using DPP-4i inhibition set at the upper physiological range limit (Tan & Flanagan, 2013). On the other hand, DPP-4i therapy has no association to weight loss or gastric emptying inhibition. Additionally, the use of the long-acting GLP-1R agonists helps in better control of glycemia since there is a longer sustenance of GLP-1R activation. The GLP-1R agonists help in the control and regulation of blood glucose by simulating insulin and inhibiting secretion of glucagon. Since the GLP-1R are glucose dependent, they prevent and minimize the risk of hypoglycemia episodes and incidences when there is no concomitant sulfonylurea therapy. Since GLP-1R activation reduces ingestion and inhibits gastric emptying, the patients using it will experience a weight loss, thereby better managing the associated illnesses in the patients (Tan & Flanagan, 2013). GLP-1 also preserves the functions of ventricular systems and as a result improves the outcomes for the patients by diminishing myocardial infractions and heart failure. Both incretin-based therapies improve hypoglycemia effectively. Due to the pharmacological concentrations in GLP-1 agonists, they result in the reduction of HbA1c. The safety and efficacy of the two agents of incretin-based therapy are durable and the more nursing practitioners appreciate their use, the more positive results will be realized among the ailing elderly patients suffering from diabetes mellitus type II.
Failure to use Incretin-Based Therapy
Failure to use the incretin-based therapies deprives the patients of some benefits. The novel effects are beneficial to patients and are not found in any other treatments of diabetes. The glucose-dependent nature of the medications and their insulinotropic effects ensure that they mimic the insulin profile as per the physiology of the patient. The tow therapies also lower the incidence of hypoglycemia, a function that is not exhibited by other diabetic treatments. Additionally, the incretin-based treatments do not result in weight gain (Drucker et al., 2010). As such, when practitioners fail to use such an evidence-based practice, the patients remain tied to the side effects of the previously administered medications. There are also benefits of the incretin-based therapies on the β-cell. The GLP-1 agonists ensure improved β-cell parameters during the treatment of the disease. If the patients are not treated using the incretin-based therapies, they will also miss out on improved cardiovascular parameters that are important for the human system. For instance, the incretin-based therapies will ensure an improved systolic pressure and preserved brain natriuretic peptide and triglycerides (Vijan, Sussman, Yudkin, & Hayward, 2014). Finally, besides the therapeutic effects of the two incretin-based therapies described above, there are other advantages that the patient would benefit from that are not derived from the traditional medications of insulin injection and orally administered agents. The two incretin-based therapies offer reduced side effects as well as improved convenience in terms of weight gain and occurrence of hypoglycemia incidences (Chew et al., 2015).
Strategy to disseminate importance of Incretin-Based Therapy
I would also raise concern to reduce healthcare costs associated with the traditional methods of addressing diabetes mellitus type II. The two new therapies are cost efficient and not only reduce the cost of treating diabetes itself but also other associated complications such as frequent hypoglycemia and excessive weight gain.
Addressing the Concerns Opposing the Change in Practice
Should there be oppositions to the nursing practice of using the incretin-based therapies, the first step would be requesting the opposition to table their concerns against the nursing practice. As such, I would come up with respective responses addressing each and every concern. An educative strategy would be organized, aimed at clearing the doubts among those opposed to the use of incretin-based therapies (Vijan et al., 2014). Evidence from different qualitative and quantitative case studies would be used to compare the effect of the traditional treatment methods to the incretin-based strategies. As such, large results from quantitative research would prove that the incretin-based strategies are better while the qualitative research results would confirm the real attitudes of the patients on the two treatment methods.
In conclusion, medical interventions are used for patients living with different conditions like Diabetes to make their lives better. There is constant research and innovations of such practices and medical professionals are required to stay informed about these practices. The selection of a practice is based on different factors like a patient’s age and the progression of the disease. The use of incretin-based therapy, as explained, has its benefits, especially for aged patients and there is a need to adopt this practice. That requires educating the nurses and other medical professionals about the therapy practice and its benefits on patients. By doing so, they are more likely to understand and accept the need to take up the practice.
References
Abdelhafiz, A. H., & Sinclair, A. J. (2015). Low HbA1c and Increased Mortality Risk-is Frailty a Confounding Factor? Aging and Disease, 6(4), 262-270. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4509475/
Chew, B., Sherina, M., & Hassan, N. (2015). Association of diabetes-related distress, depression, medication adherence, and health-related quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type 2 diabetes: A cross-sectional study. Therapeutics and Clinical Risk Management, 11, 669-681. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425326/
Drucker, D. J., Sherman, S. I., Gorelick, F. S., Bergenstal, R. M., Sherwin, R. S., & Buse, J. B. (2010). Incretin-Based Therapies for the Treatment of Type 2 Diabetes: Evaluation of the Risks and Benefits. Diabetes Care, 33(2), 428–433. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809297/
Hara, Y., Hisatomi, M., Ito, H., Nakao, M., Tsuboi, K., & Ishihara, Y. (2014). Effects of gender, age, family support, and treatment on perceived stress and coping of patients with type 2 diabetes mellitus. BioPsychoSocial Medicine, 8(1), 8-16. Retrieved from http://bpsmedicine.biomedcentral.com/articles/10.1186/1751-0759-8-16
Huang, E. S., Liu, J. Y., Moffet, H. H., John, P. M., & Karter, A. J. (2011). Glycemic Control, Complications, and Death in Older Diabetic Patients: The Diabetes and Aging Study. Diabetes Care, 34(6), 1329-1336. Retrieved from http://care.diabetesjournals.org/content/34/6/1329.full.pdf
Maryland, M., & Gonzalez, R. (2012). Patient Advocacy in the Community and Legislative Arenas. OJIN: The Online Journal of Issues in Nursing, 17(1), Manuscript 2. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocacy-in-Community-and-Legislative-Arena.html
Tan, H. K., & Flanagan, D. (2013). The impact of hypoglycaemia on patients admitted to hospital with medical emergencies. Diabetic Medicine, 30(5), 574-580. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/dme.12123/pdf
Vijan, S., Sussman, J. B., Yudkin, J. S., & Hayward, R. A. (2014). Effect of Patients’ Risks and Preferences on Health Gains With Plasma Glucose Level Lowering in Type 2 Diabetes Mellitus. The Journal of the American Medical Association, 174(8), 1227-1234. Retrieved from http://allmanmedicinbd.se/wp-content/2014/11/diabetesbehandlingsb%C3%B6rda.pdf
