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The Prevention of Type II Diabetes Mellitus

Garrett Cox

College of Nursing, Auburn University

NURS 4290: Evidence Based Practice

Dr. Katilya Ware and Dr. Stuart Pope

November 14, 2023

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Background

Type 2 diabetes is an irreversible disorder in which the body either resists insulin or does

not produce enough insulin to regulate and lower blood glucose levels. Type 2 diabetes mellitus

is a common diagnosis with 422 million people diagnosed across the globe. Over 90% of all

diabetic patients have been diagnosed with type 2 diabetes (Khan et al., 2019). The total number

of diagnoses of type 2 is projected to increase exponentially by the year 2030 with sedentary

lifestyle and obesity being the leading risk factors for the disease. It was also found that Type 2

diabetes mellitus is more common among men than women (Magalhaes et al., 2023). A

precursor to type 2 diabetes mellitus is a diagnosis of prediabetes. Since prediabetes typically

does not present with textbook symptoms, screening for prediabetes is important as 70% of

patients who are diagnosed as prediabetic will progress to full type 2 diabetes mellitus at some

point in their lifetime (Shubrook et al., 2018). It is estimated that about 33.9% of the United

States has prediabetes placing them at risk of the progression of the disease. (Cheng et al., 2022).

Type 2 diabetes is commonly associated with many other medical complications such as diabetic

neuropathy, nephropathy that can lead to end-stage renal disease, stroke, cardiovascular disease,

and can eventually result in death (Khan et al., 2019). These complications can drastically lower

the patient’s quality of life if not treated continuously and successfully. Although type 2 diabetes

cannot be cured, adherence to a treatment plan can help the patient keep their blood glucose

levels near the normal ranges (Khan et al., 2019). The following PICO question will help identify

nursing interventions that can be used to prevent a type 2 diabetes diagnosis in patients at risk:

What is the effectiveness of modifying the patient’s modifiable risk factors such as a healthy

lifestyle change versus pharmacological treatment in preventing the diagnosis of Type 2 diabetes

mellitus in the adult prediabetic population?

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The population addressed in the PICO question is adults who have been diagnosed with

clinical prediabetes, the precursor to a type 2 diabetic diagnosis. The interventions discussed to

prevent the onset of full type 2 diabetes are lifestyle changes and medication. Lifestyle changes

or modifiable risk factors include a healthy diet and exercise (Shubrook et al., 2018).

Medications include oral type 2 diabetes medication such as metformin. In comparison, lifestyle

changes have proved to have a more positive outcome in preventing type 2 diabetes than

medication use. The outcome of this specific PICO question targets the prevention of type 2

diabetes mellitus in adult patients who are diagnosed as prediabetic.

Synthesis of Evidence

Lifestyle Changes

In patients with prediabetes, lifestyle changes such as structured diets have proven to be

beneficial in delaying or preventing the onset of type 2 diabetes mellitus. Roberts et al. (2017)

and Diez-Redondo et al. (2015) define prediabetes as an elevated blood glucose level, but not

elevated enough to meet the qualifications of type 2 diabetes mellitus. Studies have shown the

most effective lifestyle intervention in decreasing blood glucose is implementing a healthier diet

(Corgatelli et al., 2022; Gardner et al., 2022; Yamaoka et al., 2019). In a randomized crossover

trial performed by Gardner et al. (2022) placing prediabetic individuals on two different

structured diets, the results proved that a healthy diet had a therapeutic effect on blood glucose

levels, triglycerides, and carbohydrates. Yamaoka et al. (2019) performed a study that proved

these structured diets are only beneficial if patient education occurs and the high risk individual

understands the importance of compliance to the diet. Corgatelli et al. (2022) understood the

importance of nutrition education and studied whether the duration of nutrition education was

effective in increasing compliance and ultimately decreasing blood glucose. The results
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supported lifestyle changes such as structured diets in the prevention of type 2 diabetes mellitus

onset, but the duration of a nutrition education program did not yield significant results.

Pharmacological Treatment

While medications can often be the first line of treatment a healthcare provider turns to

for certain illnesses, studies show pharmacological treatment alone is not the most profitable way

of preventing type 2 diabetes mellitus in prediabetic adults (Roberts et al., 2017; Shubrook et al.,

2018). Medication therapy places patients at a high risk of developing drug-specific side effects.

A systematic review by Roberts et al. (2017) studied the effects of pharmacological therapy on

the patients’ quality of life. The results showed higher quality of life patients who implemented

other interventions such as lifestyle changes compared to patients on a specific type 2 diabetes

mellitus drug, Metformin. The study showed results that lifestyle interventions combined with

pharmacological treatment are cost-effective for patients, however, not cost-saving. Moin et al.

(2018) studied the benefits of pharmacological therapy alone and results showed that Metformin

is safe and cost-effective for high risk individuals who meet specific qualifications such as high

risk patients who are 60 years of age or less or patients who have a BMI of 35 or higher.

Lifestyle Changes versus Pharmacological Treatment

Many studies support lifestyle interventions over pharmacological treatment alone as a

preventative measure for prediabetic patients (Gardner et al., 2022; Moin et al., 2018; Yamaoka

et al., 2019). Gardner et al. (2022) performed a study on high risk individuals who implemented

a strict diet. The results showed a significant decrease in HbA1C, triglycerides, and cholesterol

levels. Yamaoka et al. (2019) took this study a step further and studied lifestyle interventions

versus lifestyle interventions with pharmacological therapy. The results showed the effects of

lifestyle modifications were longer-lived than pharmacological treatment.

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Conclusion

Prediabetes is a common precursor to a type 2 diabetes mellitus diagnosis. However,

there are interventions to prevent or slow the onset of type 2 diabetes in high risk patients. As a

nurse, supplying the patient with proper education is a necessary intervention to provide the best

outcome for the patient. For a patient who is beginning pharmacological treatment, a nurse is

expected to educate the patient on signs of any possible harmful side effects. Nurses should

emphasize the importance of blood glucose monitoring in order to efficiently treat any signs of

disease progression. They should employ the teach-back method to ensure the patient

understands how to check their blood glucose levels. The nurse could consult with nutrition and

dietetics to learn about the proper diet education that should be provided for a patient at high risk

of type 2 diabetes. In essence, nurses are called to be advocates for their patients and should be a

voice for the patient ensuring that they receive the most appropriate care in the prevention of a

type 2 diabetes diagnosis.

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References

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