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Improving Glycemic Control And Quality Of Life In Adults With Type 2 Diabetes Mellitus

Using Complementary Alternative Medicine Along With Regular Therapy

Enerolisa Paredes Lixandro

NURS693-F1WW (S18)

Professor Barbara Miville

August 4, 2018

Improving Glycemic Control And Quality Of Life In Adults With Type 2 Diabetes Mellitus

Using Complementary Alternative Medicine Along With Regular Therapy

Diabetes is a complex health problem that results in significant morbidity and

mortality and health care resource utilization (Birdee, & Yeh, 2010). Diabetes is a

metabolic disease; it increases blood glucose levels due to a decreased amount of

circulating insulin. This disease leads to abnormal lipid profiles, and increased free radical

production. With projected increases in the incidence of diabetes worldwide, health systems

continue to focus on improving and optimizing diabetes care by influencing patient

behavior and improving efficiency of care (Birdee, & Yeh, 2010). Yet, providing high

quality care for diabetics still remains a challenge for healthcare systems and providers.

People with diabetes frequently use complementary and alternative medicine (CAM) and

other CAM therapies for a range of reasons. When counseling patients on CAM use,

physicians should respect patients' choices regarding self-management, while providing

evidence-based information about efficacy and safety or the lack thereof. Despite unclear

data, a large number of patients will continue using CAM in the future (Canaway, &

Manderson, 2013). As research grows in this field, physicians have an opportunity to help

patients make decisions about the most safe and effective CAM therapies to consider. It is

important that health professionals (HPs) do not assume that their patients use CAM to

‘control diabetes’ (Birdee, & Yeh, 2010).

In the United States, adults frequently use CAM, with 40% reporting use in the past

12 months. In addition, an estimated 34% of adults with diabetes mellitus use some type of

CAM therapy (Birdee, & Yeh, 2010). Although some CAM therapies have been shown to

affect glycemic control, the clinical efficacy and mechanism of many CAM therapies for

diabetes is controversial, and safety issues are a concern. Adverse effects of many CAM

therapies are not well documented (Naja, & Alameddine, 2014). Because patients with

diabetes often take multiple prescription medications, there exists the potential for herb-

drug and herb-dietary supplement interactions, leading to adverse events (Kennedy, &

Seely, 2010). At least 63% of the general population does not disclose use of CAM

therapies to their physicians (Birdee & Yeh, 2010).

The aim of the study is to investigate the effects of alternative medicine along with

regular therapy to improve glycemic control, and quality of life in patients with type 2

Diabetes within a 6-12 months’ period. The objective will be to improve glycemic control

and better quality of life in 45% of the population participating in the study. Strive to

decrease serologic measures such as cholesterol, low-density lipoprotein and triglycerides.

Another objective will be to provide a framework to advise patients on Complementary

Alternative Medicine use, and improve communization between patients and health care


Selecting the right team is important for a successful implementation of the QI

project. They will make sure that quality patient care is delivered. For the project to have a

successful outcome is important that the lines of communication between providers remain

open. There should be mutual respect between all the parties involved and shared decision-

making needs to take place. The team will be composed of the Operational Manager,

Medical Director, EBP Mentor, Chief Research Department, and Endocrinology

Department. All of the member in charge of the proper conduction of the study will address

the patients’ double blindly to avoid biases. The patients will be divided into two groups, A

and B and will receive the same lifestyle modification and present medication with the only

difference being receival of the active or placebo pill.

The utilization of the electronic health record is a must for the selection of patients.

With this tool patients that qualify will be matched and screened for the demographics and

paraclinical variables. Also, a randomize algorithm will be created so that a table of random

numbers can be created and each patient will be assigned to one of the two groups. One of

the laboratories that the company uses will be utilized for the course of the research so that

no discrepancy is created in regards to the laboratory blood work recorded.

During the study patients will have serologic measurements every 3 months. The

tests that will be performed are Cholesterol, Lipid levels and Hemoglobin A1c levels. The

evidence base in support of HbA1c as a diagnostic test for diabetes mellitus is focused on

predicting a positive clinical outcome (Thomar, 2016). In addition, decreased levels of

cholesterol, and lipid values will determine if the results lead to the outcome of the study

(Sayeed, Mostofa, Ferdous, & Islam, 2013). Effective communization between patients and

health care providers is important to develop a trusting and pleasant environment leading to

a better outcome. For patients that do not adhere to the program changes in lifestyle, these

will be reflected in the serologic measure. In those cases, patients will be referred to a

diabetes educator and follow up will be more frequent.

Blood measurements will be taken monthly and compared to the baseline. The goal

is for more than 45% of the patients to have an HbA1c decrease by the end of the three-

month pilot study. The tests will be performed on patients with uncontrolled diabetes that

go to the office within 1 week and those patients will be followed through out the course of

a three months’ period. It is very important for the team to be aware of all the objectives of

the study, so communication here is a must. Training also will be provided as required as

well as detailed protocols of the project. All departments and the individuals who may be

affected by the project will be notified.

During the implementation of the plan we need to observe how doctors nurses and

patient reacts. We will also need to know if everything goes as planned. Audit and feedback

must be obtained and all questions that emerge need to be addressed. It is important to

remember that each person contributes different by demonstrating a different set of skills

and opinions. Working with unity creates a more efficient project course.

After the implementation we will need to study the results to see if it made a

difference in the patient’s health, the provider components of care, and if it is cost effective.

We also need to evaluate if outcomes were achieved as expected. Data will be analyzed

with a table demonstrating the comparison between baseline and after results.

As a summary conclusion it is important the improved patient-provider

communization and health care support is delivered. Complementary alternative medicine

use supports chronic illness prevention and management. Herbal treatment is known to

decrease glycemic index and serologic measures (Sayeed, Mostofa, Ferdous, & Islam,

2013). One of the objectives is to increase the integration of herbal medicine for care

management and have positive outcomes. It is projected that a decreased presence of

disease complication and positive family support will occur.

It is important to inform all the parties involved in the study. These include the

stakeholders, staff involved and the internal review board if the study is to be published

(Gallagher-Ford, Fineout-Overholt, Melnyk, & Stillwell, 2011). The purpose of the project

must be clearly explained and have supporting research in order to be conducted. It is

important to understand the advantages and disadvantages that can arise and have all

members of the research informed, including test subjects. The database and screening

should be clearly defined to minimize bias or conflicting measurements so that results are

valid and the study can be replicated. Lastly, the outcome of the study most be shown.

Meaning an outcome indicator should be created demonstrating what are the results

expected. In regards to the research proposed, a good indicator that the study was a success

is if the serological values demonstrate a decrease in the studied variables and that no

toxicological measures were present.

Safety and quality are the responsibility of all practitioners providing care. CAM

exemplifies person-centered care and some are evidence- based (Dunning, 2014). CAM

non-medicines options could be considered when appropriate and safe. The person’s

individual risk of adverse effects must be considered, and CAM use documented and

monitored as part of the overall care plan. People with diabetes are high CAM users;

therefore HPs must regularly ask about CAM use in a non-judgmental way.


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