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Running head: IMPROVING GLUCOREGULATORY FUNCTION IN DIABETICS

Improving Glucoregulatory Function in Diabetic Patients Using Exercise


Michael A. Cook
University of South Florida

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Improving Glucoregulatory Function in Diabetic Patients Using Exercise
Approximately 29.1 million individuals have diabetes mellitus, a disease process that can
lead to retinopathy, neuropathy, and increased risks of cardiovascular complications such as a
coronary artery disease, and stroke (Centers for Disease Control and Prevention [CDC], 2014).
This condition, characterized by insulin resistance or insulin insufficiency, causes a malfunction
in blood glucose regulation, which can lead to hyperglycemic episodes and prolonged blood
glucose elevations. Increased glycated hemoglobin (HbA1c) levels, a measure of three-month
blood glucose patterns, are linked to increased hospitalization frequency and infection (Schneider
et al., 2016). Furthermore, hospitalized patients with diabetes mellitus are more likely to contract
hospital-acquired urinary tract infections (Redder, Leth, & Mller, 2016). These risk profiles
suggest necessary evaluation of the efficacy of alternative approaches, such as exercise, to
maintain glucoregulatory functioning. Standard diabetes education includes regular monitoring
of blood glucose levels and teachings aimed to provide an understanding of healthy blood
glucose ranges, without a component of exercise that can help to regulate blood glucose levels.
The purpose of this paper is to discuss the implementation of exercise teachings for diabetic
patients. In diabetic patients, how does aerobic and resistance exercise compared to no exercise
affect glucoregulatory parameters over a duration of six months?
Synthesis Literature Review
The PubMed and CINAHL databases were accessed to conduct a literature search. All
results were limited to randomized controlled trials between 2006 and 2016. The key search
terms included diabetes mellitus, exercise, effects, hyperglycemia, HbA1c, and blood glucose.
In diabetic patients, aerobic exercise can significantly reduce HbA1c levels and fasting
blood glucose levels (Sung & Bae, 2012). Aerobic exercise can also decrease insulin resistance

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and levels of insulin in blood plasma (Motahari-Tabari, Shirvani, Shirazed-e-Ahoodashty,
Yousefi-Abdolomaleki, & Terimourzadeh, 2014). Resistance training regimens can also decrease
HbA1c levels, as well as insulin sensitivity. (Bacchi et al., 2012). There is no statistically
significant difference between resistance training and aerobic exercise, regarding these
parameters (Bacchi et al., 2012).
Subjects who participated in exercise regimens, whether aerobic or resistance, showed
greater improvements in insulin resistance, HbA1c levels, fasting blood glucose levels and
insulin sensitivity compared to subjects who did not participate in an exercise regimen (Bacchi et
al., 2012). The patient populations in the review literature were small, ranging from forty to fiftyfour subjects, but the improvements in glucoregulation were statistically significant. However, in
the Motahari-Tabari et al., study (2014), the subjects were exclusively female and the results are
not necessarily generalizable to the general population. The findings provide evidence for the
value of exercise in diabetic populations, and this information can be extended to patients in
addidtion to standard diabetic education. If these practices are pursued by diabetic patients and
glucoregulation improves, then hospitalization rates and infection may also improve. Although
exercise improves glucoregulation, there are still knowledge gaps regarding optimal exercise
duration, intensity and frequency. Furthermore, the reviewed literature did not evaluate the
impact of both nutrition and exercise concurrently which may improve patient outcomes.
Proposed Practice Change
The literature demonstrated that exercise regimens can decrease HbA1c levels, insulin
resistance, plasma insulin levels and fasting blood glucose levels. To reduce these risks, patient
education should be provided regarding the beneficial effects of exercise, in addition to the
standard teachings regarding blood glucose monitoring procedures. Educational leaflets should

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also be distributed to diabetic patients, and future HbA1c levels should be measured during
outpatient follow-ups to evaluate progress.
Implications for Practice
This EBP project could be implemented in the Diabetes and Endocrine Center at Mease
Countryside Hospital. The organization demonstrates a willingness to pursue EBP and
recognizes the value of its implementation, but there are some clinicians who require further
education about EBP. Applying the Advancing Research and Clinical Practice Through Close
Collaboration Model may help facilitate EBP in the organization and improve its sustainability.
The model provides a five step process wherein an individual assesses an organizations
willingness to pursue evidence-based practice, identifies strengths and barriers, recognizes
mentors, incorporates EBP and evaluates outcomes (Melnyk & Overholt, 2015).
The recognition of EBP mentors, who function as EBP educators in the organization,
would help ensure that the clinical staff is informed about the EBP process. It would also be
valuable to develop a team of EBP champions, who assess the implementation of EBP practices
and evaluate their efficacy. This EBP project requires the addition of exercise education for
diabetic patients, the distribution of educational leaflets, and future monitoring of HbA1c levels.
EBP mentors can educate nurses about the evidence regarding the effects of exercise on
glucoregulation, and EBP champions can ensure that education leaflets are provided to diabetic
patients. Future HbA1c levels can be measured at outpatient follow-up visits, and the outcomes
can be evaluated by EBP champions.
Reductions in insulin resistance, plasma insulin levels, HbA1c levels and fasting blood
glucose are expected outcomes of implementing exercise regimens into diabetic care. The nurses
role in this practice will be to provide education regarding the beneficial effects of exercise on

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glucoregulation and the distribution of educational leaflets. The expected outcomes are
contingent upon the implementation of exercise regimens by the patients outside of the clinical
facility.
Ethical Considerations
Beneficence and non-maleficence are fundamental to this EBP project as the intention is
to improve patient outcomes and reduce the risk of hospitalizations, cardiovascular
complications and infection. Autonomy allows patients to consider a larger array of potential
interventions aimed at improving their glucose regulation. This broader array of interventions
allows the patient to make their own decisions regarding their diabetes management. The
literature states that improved glucoregulation can be obtained through exercise measures.
Glucoregulation may empower may empower patients to be more involved in their own health
outcomes.
This practice change can be sustained by incorporating EBP champions who inform
clinicians about the current status of the data regarding the effects of exercise on glucoregulation.
Nurses will also be required to include this information in their standard diabetes teaching, and
EBP champions can help evaluate the efficacy of this intervention. An additional mechanism to
sustain this practice would be to provide educational leaflets describing the glucoregulatory
benefits of exercise in the discharge paperwork provided to each patient. The efficacy of this
practice can also be evaluated by EBP champions.
Conclusion
Exercise can improve glucoregulation and decrease insulin resistance, fasting blood
glucose and HbA1c levels in diabetic patients. Including information about the benefits of
exercise in standard diabetes education may improve patient outcomes by reducing

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cardiovascular complications, hospitalization and infection rates, which are correlated with
elevated HbA1c levels (Nichols, Joshua-Gotlib, & Parasuraman, 2014). The implementation of
this practice change requires the communication of extra educational information to diabetic
patient, the recognition of EBP mentors and champions, and the distribution of educational
leaflets.

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References
American Diabetes Association (2015). Physical activity guidelines. Retrieved from
http://www.diabetes.org/food-and-fitness/fitness/types-of-activity/what-werecommend.html
Bacchi, E., Negri, C., Zanolin, M., Milanese, C., Faccioli, N., Trombetta, M., & ... Moghetti, P.
(2012). Metabolic effects of aerobic training and resistance training in type 2 diabetic
subjects: A randomized controlled trial (the RAED2 study). Diabetes Care, 35(4), 676682.
Center for Disease Control and Prevention (2014). National diabetes statistics report. Retrieved
from http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf
Melnyk, B.M. & Overholt, E.F. (2015) Evidence-based practice in nursing & healthcare: A
guide to best practice (3rd ed.). Philadephia, PA: Wolters Kluwer
Motahari-Tabari, N., Shirvani, M.A., Shirazed-e-Ahoodashty, M., Yousefi-Abdolomaleki, E., &
Terimourzadeh, M. (2014). The effect of 8 weeks aerobic exercise on insulin resistance in
type 2 diabetes: A randomized clinical trial. Global Journal of Health Science, 7(1). doi:
10.5539/gjhs.v7n1p115
Nichols, G. A., Joshua-Gotlib, S., & Parasuraman, S. (2013). Glycemic control and risk of
cardiovascular disease hospitalization and all-cause mortality. Journal Of The American
College Of Cardiology, 11(2), 121. doi:10.1016/j.jacc.2013.04.031
Redder, J., Leth, R., & Mller, J. (2016). Analysing risk factors for urinary tract infection based
on automated monitoring of hospital-acquired infection. Journal Of Hospital Infection,
92(4). doi:10.1016/j.jhin.2015.12.009

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Schneider, A. C., Kalyani, R. R., Golden, S., Stearns, S. C., Wruck, L., Yeh, H. C., & ... Selvin,
E. (2016). Diabetes and prediabetes and risk of hospitalization: The atherosclerosis risk in
communities (ARIC) study. Diabetes Care, 39(50). doi:10.2337/dc15-1335
Sung, K., & Bae, S. (2012). Effects of a regular walking exercise program on behavioral and
biochemical aspects in elderly people with type II diabetes. Nursing & Health Sciences,
14(4). doi:10.1111/j.1442-2018.2012.00690.x

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