Delivery in day(s): 4
MD0583 Introduction to Diabetes Editing Services
Evaluation of research
In this study, the authors used a randomised clinical trial to determine the impact of aerobic exercise on insulin resistance among persons with type 2 diabetes. The research is motivated by the finding that approaches to reduce insulin resistance might be combined with other effective treatments. A population sample of 53 women with type II diabetes was recruited for the research business and categorized into two groups. The groups included 27 women in exercise training and 26 females in the control group. Importantly, the women in the exercise group were exposed to an 8-week aerobic exercise to evaluate insulin resistance. The exercises involved flexibility and stretching for ten minutes, 30-minute walk with a 60 per cent rise in heart rate and 10-minute stretch in a while seated. All the participants in the exercise group performed these exercises three times a week for eight weeks. Further, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) is utilized to examine insulin resistance in the sample population. Based on the results, aerobic exercises decreased blood glucose in the 27 women substantially. In essence, the results imply that aerobic exercises are effective in glycemic control. Ethics were observed in this study since there was informed consent. All the participants were first briefed about the study process and interventions.
The research topic is the impact of exercise on glycemic control in patients/adults with type II diabetes. Importantly, diabetes is among the leading causes of mortality and disability around the country. As of 2016, about one in every 1,500 Australians was taking insulin to manage type II diabetes (AIHW, 2018). Between 2009 and 2014, approximately 152,634 deaths were recorded in the people diagnosed with type II diabetes (AIHW, 2017). Importantly, healthcare professionals should focus on the medical areas of priority to improve the quality of life for the general population. In this study, exercise has been chosen as the intervention because it is practical and simple to implement in the community to improve the health outcomes of the adults with chronic conditions. Besides, exercise is an effective care that increases the engagement of the persons with diabetes. In terms of practicality, exercise intervention is practical because it creates a supportive system, an information sharing environment and it is simple to measure the success after a given period. Besides, the proposed health intervention in this study can be tailored for priority groups such as the indigenous Australians in the rural areas. Exercises are a means to promote health, which creates a healthier population in the community. The topic is ideal because the intervention would reduce the risk of disability and mortality for adults diagnosed with type II diabetes across Australia. Essentially, the topic is directly related to enhancing the health outcomes for persons with type II diabetes through effective and cost-effective glycemic control.
The research evidence suggests that nurses and other healthcare providers can play a great role to improve the outcomes of persons with chronic conditions. Most important, the literature points towards the adoption of non-pharmacological methods including exercises in the treatment, management and prevention of diabetes. Nursing practice needs to advocate for regular exercises for patients diagnosed with type II diabetes. Najafipour et al. (2017) found that regular exercise training has a substantial impact on haemoglobin A1c (HbA1c). Nevertheless, health care professionals should determine how often or regular patients with type II diabetes should be exposed to exercise training. In an effort to answer this question, Hamasaki (2016) asserts that daily physical activity improved metabolism that is essential in diabetic management. Motahari-Tabari et al. (2015) developed an intervention whereby the participants engaged in physical activity three times a day. The findings indicate that nurses should focus on developing a long-term exercise intervention that fosters daily participation. Nurses can design this treatment plan and implement it in health care settings and community settings. Rossen et al. (2015), develops and compares the efficacy of different physical activities in primary care settings. In a randomised study, the participants are randomly allocated to a control group, a pedometer group or a multi-component intervention group and followed for up to 24 hours (Rossen et al., 2015). Recent research has found that the benefits of exercises in insulin sensitivity persist for between 48 and 72 hours and might even be reported beyond the 72 hours (Way, Hackett, Baker & Johnson, 2016).
Nurses should also determine the most effective exercises for adults diagnosed with type II diabetes. Even though there are many exercise training that can be administered to patients with chronic conditions, certain exercise might be more effective than others. Motahari-Tabari et al. (2015) designed a study to establish the effectiveness of aerobic exercises. In the study, the authors found that aerobic exercises help to lower plasma glucose meaning that these exercises are effective. On the other hand, circuit resistance training has also been found to be produce positive outcomes in glycemic control in women diagnosed with type 2 diabetes (Shabani, Nazari, Dalili & Rad, 2015). Circuit resistance training involves a combination of physical exercises such as warming up, cooling and repetition of different tests (Shabani et al., 2015). Based on these findings, it is evident that different forms of exercises can be implemented in the management of type II diabetes in adults.
Nevertheless, health care providers should implement exercises that are suitable for the target population meaning that they should use a patient-centred care approach. The designing of custom exercise is supported by the fact that the ideal technique for enhancing glucose control and minimising cardiometabolic risk in diabetic patients not been established (Francois & Little, 2015). Other types of exercises that have been proposed for patients with type II diabetes include endurance-type exercise, joba riding and yoga classes (Thent, Das & Henry, 2013). Healthcare providers should acknowledge that the intensity of exercise is an important predictor of the outcome. Therefore, this fact should guide them when designing exercise therapy in primary care settings, community settings or aged care facilities. The most important implication is that they can design exercise therapy for active and weak patients. Francois and Little (2015), argues that the intensity, type of exercise, and duration play a fundamental role in the level of employee benefits achieved. Some patients with type 2 diabetes might be physically weak to perform the prescribed intensity of physical activity (Hamasaki, 2016). Despite the condition of the patient with type II diabetes, physical activity should be designed to fit into their daily life without increasing a substantial burden.
As nurses design exercise therapy for patients with diabetes, they should understand how exercises impact the patient. Exercises foster a rise in bioavailability of nitric oxide and result in a decline in post-exercise blood pressure (Asano, 2014). In addition, exercise lead to metabolic stress that increases carbohydrate oxidation, increase fat oxidation and enhance glucose tolerance (Asano, 2014). During exercises, insulin sensitivity increases and leads to a decline in glycemia volumes between 2 and 72 hours (Asano, 2014). Similarly, Francois and Little (2015) assert that exercises are ideal for persons with diabetes. These authors argue that exercise offers extra health benefits specifically for blood glucose control and act as a vital intervention in the prevention and treatment of diabetes and the adverse events linked to type II diabetes (Francois & Little, 2015).
Based on the literature review, nurses should encourage adults with diabetes to adopt a lifestyle change whereby physical activity is a part of the daily activities. Asif (2014) acknowledges that changing lifestyle to include activities such as walking can help to prevent and treat diabetes. In essence, recent literature has found that exercises have many benefits for adults with type II diabetes.
Recommendation Future Research
Future research in this area should establish whether different exercises result in similar benefits for adults with type 2 diabetes. Since different exercises have been proposed, it is essential to determine whether the patients will attain the same benefits in the long term in terms of glycemic control. A randomised study should be designed for this future research whereby patients with type II diabetes are randomly recruited. In this case, a large sample size of about 200 adults would help to deliver reproducible outcomes. The patients should be divided into four groups and each exposed to a different kind of exercises including aerobic exercise, circuit resistance training, yoga and joba riding. Before the interventions are initiated, all participants should be informed about the risks, mode of physical activity and the expected outcomes. At this point, patients who want to quit the research should be given a chance and not restrained. The 200 patients should be subjected to similar measures to determine how their physical activity affects glycemic control. In case some patients are unable to continue with the assigned physical activity, they should be discontinued. Essentially, this research will be fundamental for nursing practice because it will determine whether different exercises have similar benefits.
1. AIHW. (2017). Deaths among people with diabetes in Australia, 2009-2014. Australian Institute of Health and Welfare. Retrieved from https://www.aihw.gov.au/getmedia/c164ec7c-fc66-4991-8e53-62eba274ead4/aihw-cvd-79.pdf.aspx?inline=true
2. AIHW. (2018). Incidence of insulin-treated diabetes in Australia. Australian Institute of Health and Welfare. Retrieved from https://www.aihw.gov.au/reports/diabetes/incidence-insulin-treated-diabetes-australia-2016/contents/introduction
3. Asano, R. Y., Sales, M. M., Browne, R. A. V., Moraes, J. F. V. N., Júnior, H. J. C., Moraes, M. R., & Simões, H. G. (2014). Acute effects of physical exercise in type 2 diabetes: a review. World journal of diabetes, 5(5), 659-665. Doi: 10.4239/wjd.v5.i5.659.
4. Asif, M. (2014). The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. Journal of education and health promotion, 3, 1. Doi: 10.4103/2277-9531.127541.
5. Francois, M. E., & Little, J. P. (2015). Effectiveness and safety of high-intensity interval training in patients with type 2 diabetes. Diabetes Spectrum, 28(1), 39-44. Doi: 10.2337/diaspect.28.1.39.
6. Hamasaki, H. (2016). Daily physical activity and type 2 diabetes: a review. World journal of diabetes, 7(12), 243-251. Doi: 10.4239/wjd.v7.i12.243.
7. Motahari-Tabari, N., Shirvani, M. A., Shirzad-e-Ahoodashty, M., Yousefi-Abdolmaleki, E., &Teimourzadeh, M. (2015). 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), 115-121. Doi: 10.5539/gjhs.v7n1p115.
8. Najafipour, F., Mobasseri, M., Yavari, A., Nadrian, H., Aliasgarzadeh, A., Abbasi, N. M., ... & Sadra, V. (2017). Effect of regular exercise training on changes in HbA1c, BMI and VO2max among patients with type 2 diabetes mellitus: an 8-year trial. BMJ Open Diabetes Research and Care, 5(1), e000414. Doi: 10.1136/bmjdrc-2017-000414.
9. Rossen, J., Yngve, A., Hagströmer, M., Brismar, K., Ainsworth, B. E., Iskull, C., ... & Johansson, U. B. (2015). Physical activity promotion in the primary care setting in pre-and type 2 diabetes-the Sophia step study, an RCT. BMC public health, 15(1), 647. Doi: 10.1186/s12889-015-1941-9.
10. Shabani, R., Nazari, M., Dalili, S., & Rad, A. H. (2015).Effect of circuit resistance training on glycemic control of females with diabetes Type II. International journal of preventive medicine, 6, 34. Doi: 10.4103/2008-7802.154923.
11. Thent, Z. C., Das, S., & Henry, L. J. (2013). Role of exercise in the project management of diabetes mellitus: the global scenario. PloS one, 8(11), e80436. Doi: 10.1371/journal.pone.0080436.
12. Way, K. L., Hackett, D. A., Baker, M. K., & Johnson, N. A. (2016). The effect of regular exercise on insulin sensitivity in type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes & metabolism journal, 40(4), 253-271. Doi: 10.4093/dmj.2016.40.4.253.
Annotated bibliography of the three articles
1. Najafipour et al. (2017)
This article determines the impacts of regular exercises on biological indicators for individuals with type II diabetes. 65 patients aged between 33 and 69 years were included in the study and divided into 35 females in experiment and 30 in control groups. 30 women completed the 8-year program, which involved aerobic exercises and their biological indicators were measured. The experiment group realised a significant reduction in BMI and HbA1c.
2. Motahari-Tabari et al. (2015)
This article uses a randomised method to determine the impact of aerobic exercise on insulin resistance in patients diagnosed with type II diabetes. 27 diabetic women are exposed to aerobic exercise for 8 weeks, and their plasma glucose is accessed. These women were compared to a control group of 26 women. The results indicate that the 27 women experienced a significant decline in plasma glucose.
3. Shabani et al. (2015)
The authors designed a study to determine the impact of circuit resistance training on controlling glycemic levels in women with diabetes. In this article, twenty obese and overweight females diagnosed with type 2 diabetes were randomly recruited in this study and subjected to the training for three days per week for three months. The results show that the women experienced a significant change in HbA1c