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
Mudanças Na Composição Corporal Com Dieta Hipocalórica Combinada Com Atividade Física Sedentária, Moderada e Intensa - Um Ensaio Clínico Randomizado - Inglês