Diabetes mellitus refers to a chronic syndrome of the metabolic system characterized by high, persistent glucose levels in the blood, which are caused by relative or absolute deficiency of the insulin hormone (Copstead & Banasik, 2012). Multiple studies have been conducted to determine the best approach for handling and managing the condition in order to control the perceived increase in prevalence. This paper seeks to identify a research paper that tackled the most current diabetes management strategy, critically analyzing its findings in terms of its relevance to diabetes management, and establishing its relevance to nursing practice. After a thorough literature search, the Sussman et al. (2015) paper titled, “Improving diabetes prevention with benefit-based tailored treatment: risk-based reanalysis of Diabetes Prevention Program” was selected as the paper of choice for the intended practice.
Sussman et al. (2015) sought to determine the most effective diabetes management strategy among the two primary approaches advocated by the American Diabetes Association (ADA); that is, The Structured Lifestyle Program and Metformin use. The researchers achieved the objective by analyzing the nature of patients under the Diabetes Prevention Program, who were more likely to have the best clinical outcomes from any of the management programs. The research was based on the argument that although the ADA recommends that the uses of Metformin and Intensive Lifestyle Interventions to prevent the occurrence of diabetes in the diabetes high-risk populations, the interventions have little impact on pre-diabetic patients under either of the treatment strategies, with most of the patients progressing to diabetes. They further argued that there exist tremendous financial and structural challenges in organizing and implementing effective lifestyle modification programs. Metformin, on the other hand, was thought to have numerous side effects that outweigh its therapeutic value (Knowler et al., 2002). Consequently, the researchers hypothesized that proper understanding of patients who are more likely to benefit from either of the programs will improve the efficient and effectiveness of the intervention.
The study had 3081 subjects as the sample size. Moreover, the subjects had poor glucose metabolism. These participants were divided into two different intervention groups, where one received metformin while the other underwent the lifestyle modification strategy. The participants were then followed to determine the rate of physical activity and weight loss. Onset of diabetes was selected as the principal outcome determinant. The primary outcome factor was classified depending on the risk of diabetes development, as per the “Diabetes Risk Development Model.” According to the findings of this study, the model mentioned above had a perfect calibration and discrimination, with a C statistic value of 0.73.
At the end of the research, 21% of the participants (655 out of the total 3081), developed diabetes over 2.8 years of follow-up. The lifestyle modification strategy was found to be the most effective, having produced risk reduction in both higher and lower risk quarters. However, the approach was seen to be better in the higher risk quarter, after producing a six-fold better risk reduction (28.3%) compared to a substantial risk reduction rate of 4.9% in the lower risk quarter within three years of follow-up. On the other hand, Metformin was shown to have its benefits only in the highest risk quarter, but no impact on the lower risk quarter. However, its risk reduction rate even in the higher risk quarter was still small compared to the lifestyle modification strategy, with a reduction rate of 21.4% after three years follow-up.
Using these findings, the authors concluded that there exist significant variations in the benefits diabetic patients receive from any treatment strategy, depending on the level of risk. The researchers, therefore, recommended that employing this information in decision-making will mainly reduce instances of overtreatment, as well as make prevention more effective, efficient, and highly patient-centered. However, the classification of patients as either high risk or low risk should be based entirely on accurate and reliable risk prediction tools.
Nursing Practice Implications
Nurses have a vital responsibility in managing diabetes patients, controlling the onset of diabetes in pre-diabetic persons, as well as offering guidance and services that can protect the general population from developing diabetic risk characteristics. If nurses understand and apply the findings of the Sussma et al. (2015) study, they can make treatment and prevention of diabetes more efficient, cost-effective, as well as reduce the associated side effects. They can also reduce the nursing load in the process, as they would not need to handle the associated side effects of unmanaged, diabetes, and the proportion of diabetic patients would reduce substantially. Metformin has been in use, even though it has been shown to cause significant gastrointestinal adverse effects that predispose one to lactic acidosis. Employing the scientific findings of this study can help nurses have an evidence-based justification for applying any of the ADA recommendations to the right population at the right time. Consequently, nurses can be able to offer best nursing, treatment, and advisory services to patients and the public, in general, thereby improving treatment outcomes and the living standards of diabetic patients and their families.
Lifestyle modification strategies and the use of Metformin remain the ideal medication approaches toward the management of diabetes mellitus. However, the choice of the strategy to apply to a given population should be based on the risk status of the population, as determined by any given accurate and highly reliable risk prediction tool.
Copstead, L. C., & Banasik, J. L. (2012). Pathophysiology (5th ed.). St. Louis, MO: Saunders Elsevier.
Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F… & Lachin, J. M. et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346, 393-403.
Sussma, J., Kent, D. M., Nelson, J. P., & Hayward, R. A. (2015). Improving diabetes prevention with benefit based tailored treatment: risk based reanalysis of Diabetes Prevention Program. BMJ, 350, Web.