Evidence based practice project paper on diabetes

EVIDENCE -BASED PRACTICE PROJECT - PAPER ON DIABETES 1

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EVIDENCE -BASED PRACTICE PROJECT-PAPER ON DIABETES

Evidence- Based Practice Project- Paper on Diabetes

Ishwari Basnet

Grand Canyon University: NRS-410V

February 13th 2016

Evidence -Based practice project- Closed Loop Insulin Delivery System on Type 1 Diabetes

Type 1diabetes is a T-cell mediated autoimmune disease with increased morbidity and mortality leading to low quality life and its prevalence is sky-rocketing. Different methods and technology have been implemented to control the diabetes. This paper will describe about the research project which is about treatment of patients with type 1 diabetes with close loop insulin delivery system. A closed-loop insulin delivery system (also known as artificial pancreas) is one of the best therapeutic approaches by the researchers for the control of blood glucose level in type 1 diabetes till now. “The artificial pancreas is a system of integrated devices containing only synthetic materials, which substitutes for a pancreas by sensing plasma glucose concentration, calculating the amount of insulin needed, and then delivering the correct amount of insulin” (Sasi & Elmalki, 2013).
Research and Clinical Findings:

Among the various research articles on diabetes, “Home Use of an Artificial Beta Cell in Type 1 Diabetes” by Thabit et al is a very resourceful paper that was published in The New England Journal of Medicine in 2015. This research paper tests the practicability, efficiency and safety of artificial pancreas in the home settings. It is crossover, randomized controlled studies which included the 58 people of two age group [(6-18 years) - 25 participants & above 18 years- 33 participants] with type 1 diabetes and the duration of the study is 12 weeks. During the tenure of this study, closed-loop insulin delivery system was compared with the sensor-augmented pump therapy; adult group used the closed-loop day and night while the children group used overnight only for 12 weeks while the sensor augmented pump therapy for control group for a similar period. However, continuous glucose-monitoring device (CGMD) has been wore by both study and control group. By the use of CGMD, glucose level ranging 70 to 180 mg per deciliter is considered as the primary end point for adult group and 70 to 145 mg per deciliter for children group (Thabit et al., 2015).

This study illustrates the efficacy of CLIDS over SAP in both adult and children population for controlling blood glucose level. The glucose level was maintained at the target level with the use of CLIDS, in comparison to SAP, during day and night for adults and during night for children. In addition to this, the use of CLIDS resulted in reduced hypoglycemia and it also lowered the mean glycated hemoglobin level in adults during the study period. The use of CLIDS helps the diabetes patients (adults and children) to control glucose level and diminish the burden of hypoglycemia at home under free living condition without supervision (Thabit et al., 2015).

Significance of the Study in Diabetes and Nursing Practice

Diabetic patients before 1920s were confined to lead a poor quality life and a shortened life span due to the lack of treatment options. However, with the advancement in diabetes technology (insulin therapy and modern insulin regimens), diabetic patients have begin to lead a quality of life with improved care (Hay, 2010). Furthermore, to overcome the different drawbacks and challenges with the intensive insulin therapy, to enhance the blood glucose control, hypoglycemia prevention, postprandial control and to maintain a standard life style including exercises, closed-loop insulin delivery system is introduced (Thabit & Hovorka, 2012). This research paper is very important as the CLIDS used by type 1 diabetic patients in free living home settings without supervision has been efficiently working with the reduction of risk of hypoglycemia. Moreover, Young children are susceptible to the effects of neuroglycopenia such as seizures, which are related to hypoglycemia when they sleep. Thus, overnight closed-loop delivery helps to reduce the risk of hypoglycemia in children.

With the increase in diabetes cases, nurses have a key role as specialists or as part of general care to play in the prevention, treatment and management of diabetes. Diabetes causes many complications such as kidney, eye and nerve problems. Therefore, its control and management is very crucial. Screening for the early diagnosis of diabetes, recommendation of patients to respective doctors for treatment, help patients to achieve therapeutic goal and evaluate the further long-term complications are some of the major responsibilities of nurses. This paper concludes that “extended use of a closed-loop system at home over a period of 12 weeks during free daily living without close supervision is feasible in adults, children, and adolescents with type 1 diabetes” (Thabit et al., 2015). And this result helps in nursing practice by recommending CLIDS over SAP and it may also help in educating patients about the efficacy of CLIDS which may lead to improved quality of life.

To conclude, this paper brings a radical change in the treatment of Type I diabetic patients which will ultimately improve the lifestyle of patients.

References

Hay, K. E., (2010). The roles of open loop insulin delivery system and the artificial pancreas in diabetes treatment. Master’s and Doctoral Projects. Paper 328. http://utdr.utoledo.edu/graduate-projects/328

Sasi, A., & Elmalki, M. (2013). Design and Analysis of a Sliding Table Controller for Diabetes. ICA, 04(03), 301-308. http://dx.doi.org/10.4236/ica.2013.43035

Thabit, H., & Hovorka, R. (2012). Closed-Loop Insulin Delivery in Type 1 Diabetes. Endocrinology And Metabolism Clinics Of North America, 41(1), 105-117. http://dx.doi.org/10.1016/j.ecl.2011.12.003

Thabit, H., Tauschmann, M., Allen, J., Leelarathna, L., Hartnell, S., & Wilinska, M. et al. (2015). Home Use of an Artificial Beta Cell in Type 1 Diabetes. New England Journal Of Medicine, 373(22), 2129-2140. http://dx.doi.org/10.1056/nejmoa1509351