PICOT Question

Innumerable medicines and drugs are used by doctors with the aim to improve the glycemic level of patients who have Type 2 diabetes.  As mentioned by Clemens et al. (2016), due to diabetes, chronic and end-stage renal disease are caused. The International Diabetes Federation or IDF has claimed that Type 2 diabetes mellitus or T2DM is an international pandemic. The impaired secretion of insulin and the resistance of the tissues secreting insulin contribute to the medicine intake of T2DM. In today’s’ medical world, T2DM is quite a prevalent disease and is a major health concern around the world. Garber et al. (2016) stated that it had been estimated by IDF that nearly 387 million are diagnosed with diabetes, and 60-70% of them have developed T2DM. It increases the risks of several health complications such as kidney failure, vision loss, stroke, and premature death. In this assignment, the evidence-based article on T2DM, case study, study approach, sample, and population will be discussed. Along with this, the outcomes and identification of reliability, validity and biases of the study will also be discussed.

Evidence-based Quantitative Article

The T2Dm is caused due to dysfunction of the endocrine system and is chronic in nature. In this section, a quantitative article based on T2DM will be discussed. Mr. X from the USA has been admitted to the hospital with Microalbuminuria and Type 2 Diabetes. Mr. X was a local English teacher at a high school near Manhattan (Green et al. 2015). At the age of 52, he was diagnosed with T2DM. He was a regular smoker and occasional drinker, and both these practices were left at the age of 45 years. Due to smoking and consuming alcohol, his weight increased immensely, and his weight was nearly 230 pounds and his height was 5’9 inches. After leaving smoking and drinking, he continued to remain obese. But, after he was admitted to the hospital due to T2DM, the doctors advised him to take up medications rather than using insulin. It, therefore, made Mr. X follow a strict diet and exercise regime (Inzucchi et al. 2015).

Within 4 months of this strict regime, Mr. X lost nearly 30 pounds. Moreover, the doctors prescribed him medicines of controlling the insulin secretion within his body, instead of providing external insulin for it. Within 6 months, it was seen that he lost 50 pounds and his blood pressure was 160/100 mm Hg, and his heartbeat had a pulse rate of nearly 84beats/ min (Jafari & Britton, 2016). The doctors checked him thoroughly, and there was no evidence of peripheral vascular blockage or congestive heart failure. The hospital laboratory also tested the protein traces in Mr. X’s urine through urinalysis. It was seen that the blood urea nitrogen contained nearly 14mg/dl, random serum glucose was 169 mg/dl, and the serum creatinine contain was 1,2mg/dl. Even more, the urine collection of 24 hours revealed that the excretion rate of urinary albumin was nearly 250mg/day (Kahn, Cooper & Del Prato, 2014).

Summarizing the Case-Study

The case study shows that early detection, as well as treatment of albuminuria, is quite important and essential in cases of diabetes. As stated by Kohan et al. (2014), in the case of T2DM, elevated blood sugar levels due to the insufficiencies of the pancreas help in regulating the metabolism of the body. Insulin is one of the key regulators that take an active part in the entire metabolism of the body. As seen in the case above discussed, in T2DM, the human body is not responding properly to insulin secretion, and a condition of resistance towards insulin is created. The pancreas also becomes unable to produce insulin for overcoming resistance. According to Li et al. (2014), there are several causes of the occurrence of T2DM such as obesity, inactivity, age, family history, smoking, drinking, etc. As seen in the case of Mr. X, the doctor has prescribed oral medications, healthy diet, and regular exercise for meeting the target glucose levels in the blood.

Model (2015) stated that the treatment of T2DM is becoming increasingly complex with the introduction of new and innovative oral therapies in the global market. The continuation of oral medications helps in simplifying the initiation of insulin and also it also gives a possibility to the patients in the improvement of their glycemic control. As per the ADA (American Diabetes Association) and EASD (European Association for the Study of Diabetes), the consensus algorithm is being released for the initiation as well as adjustment of the therapy for the treatment of Type 2 DM. As mentioned by Neal et al. (2015), oral treatment is based on clinical trials, which enhances the safety and efficiency of curing Type 2 DM. In the case of Mr. X, oral medication has been given which is followed by regular exercise and a strict diet regime. The oral medications helped Mr. X in improving glycemic control and reduce the risk of hypoglycemia. The treatment of the patients and the responses of their bodies to the oral medication decides the continuation of the oral therapies.

Study Approach, Sample Size, and Population

Oral medicines are the tools that help patients in stepping up and reach the targeted blood glucose levels. As mentioned by Vijan et al. (2014), the study sample has been collected through secondary research. The researcher has studied several books, articles, and websites of PubMed, for reviewing the studies regarding the medication of diabetic patients. It is seen that the sample taken by the researcher for this case study is of Mr. X, who was admitted to the hospital with Type 2 DM. It is seen that though the patient had left smoking and drinking long years and is still obese, the doctors initially asked him to reduce his weight and provided him with oral medications. According to White et al. (2013), through oral medications, exercise, and diet, the overall weight of the patient was reduced considerably. It was also seen that due to oral medication, the patient’s insulin secretion became normal and the cells reduced their resistance towards insulin, which reduced the sugar level of the patients.

Evaluating the Outcomes and Identifying the Reliability and Validity

Type 2 DM is caused when the human pancreas is not able to produce a sufficient amount of insulin hormone, which leads to the body tissues becoming resistant to the normal level of insulin. It increases the glucose level in the blood and complications arise when it is not treated. As mentioned by Raj, Sahay & Tripathi (2016), patients suffering from Type 2 DM need regular monitoring as well as ongoing treatment for maintaining normal sugar levels in the blood. While the researcher was discussing the case study, it is seen that doctors and medical practitioners nowadays prefer oral medication before using insulin into the blood. The reliability and validity of the results can be seen through the improvements among the patients on the application of oral medications instead of insulin. The case of Mr. X shows that the condition of the patient has improved on the application of oral medications, instead of insulin. There are several cases, which show the initial usage of insulin causes renal failure and infection, where people may face early death (Samsom et al. 2016).

Brassiness of the Study

The study is unbiased in nature, as the researcher has done vivid secondary research to find out examples of patients; who are treated with oral medication, instead of insulin. The doctors claim that the usage of insulin causes renal diseases and at the early stage, the body becomes dependent on the insulin, rather than regulating its functionalities (Scirica et al. 2013). It has been claimed by doctors that the early stage of in-taking insulin reduces the metabolism and also lowers the dietary intake due to the decreasing appetite of the patients.

Conclusion

The overall assignment deals with the usage of oral anti-diabetic medication to reduce the risk of kidney disease as compared to insulin use. It is discussed that the patients are infected with renal diseases due to the sensitivity and continuous usage of insulin. A case study of Mr. X has been discussed, which shows that he was suffering from Type 2 DM and was admitted to the hospital. The doctors, after a thorough check-up decided to provide him with oral medications followed by exercise and a strict diet, instead of insulin.  Within a few months of the oral medication, Mr. X had a positive response to the oral medication and the lifestyle provided by the doctors. It helped him to regulate insulin production and reduced the resistance of the body against it. This example proved the reliability and validity of oral medication. Even the ADA and EASD also are showing reports of several patients where oral medication has helped the patients to lead a normal life, without taking insulin. Even more, the study conducted is quite unbiased in nature, which also proved that Type 2 DM could be treated easily through oral medication, instead of in-taking insulin.

References

Clemens, K. K., Liu, K., Shariff, S., Schernthaner, G., Tangri, N., & Garg, A. X. (2016). Secular trends in antihyperglycaemic medication prescriptions in older adults with diabetes and chronic kidney disease: 2004–2013. Diabetes, Obesity and Metabolism, 18(6), 607-614.

Garber, A. J., Abrahamson, M. J., Barzilay, J. I., Blonde, L., Bloomgarden, Z. T., Bush, M. A., … & Garber, J. R. (2016). Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm–2016 executive summary. Endocrine Practice, 22(1), 84-113.

Green, J. B., Bethel, M. A., Armstrong, P. W., Buse, J. B., Engel, S. S., Garg, J., … & Lachin, J. M. (2015). Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. New England Journal of Medicine, 373(3), 232-242.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes care, 38(1), 140-149.

Jafari, B., & Britton, M. E. (2016). Clinical pharmacy: Hypoglycaemia in elderly patients with type 2 diabetes mellitus: a review of risk factors, consequences and prevention. AJP: The Australian Journal of Pharmacy, 97(1147), 71.

Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083.

Kohan, D. E., Fioretto, P., Tang, W., & List, J. F. (2014). Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control. Kidney international, 85(4), 962-971.

Li, L., Shen, J., Bala, M. M., Busse, J. W., Ebrahim, S., Vandvik, P. O., … & Guyatt, G. H. (2014). Incretin treatment and risk of pancreatitis in patients with type 2 diabetes mellitus: systematic review and meta-analysis of randomised and non-randomised studies. Bmj, 348, g2366.

Model, C. C. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Diabetes care, 38(1), S1-S94.

Neal, B., Perkovic, V., de Zeeuw, D., Mahaffey, K. W., Fulcher, G., Ways, K., … & Jiang, J. (2015). Efficacy and safety of canagliflozin, an inhibitor of sodium–glucose cotransporter 2, when used in conjunction with insulin therapy in patients with type 2 diabetes. Diabetes Care, 38(3), 403-411.

Raj, R., Sahay, S., & Tripathi, J. (2016). Medications of diabetes mellitus and antidiabetic medicinal plants: A review. Drugs, 1(1), 19-28.

Samsom, M., Trivedi, T., Orekoya, O., & Vyas, S. (2016). Understanding the importance of gene and environment in the etiology and prevention of type 2 diabetes mellitus in high-risk populations. Oral health case reports, 2(1).

Scirica, B. M., Bhatt, D. L., Braunwald, E., Steg, P. G., Davidson, J., Hirshberg, B., … & Cavender, M. A. (2013). Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. New England Journal of Medicine, 369(14), 1317-1326.

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. JAMA internal medicine, 174(8), 1227-1234.

White, W. B., Cannon, C. P., Heller, S. R., Nissen, S. E., Bergenstal, R. M., Bakris, G. L., … & Wilson, C. (2013). Alogliptin after acute coronary syndrome in patients with type 2 diabetes. New England Journal of Medicine, 369(14), 1327-1335.