Acceptable Recruitment Methods
Acceptable Method of Selection of Controls

Minimization of Bias

Were the Confounders Accounted for in the Study Design

Are the Results Believable

Are They Applicable to Other Populations (Generalizable)

Do the Results Fit with Available Evidence

Jorde & Figenschau, 2009

Yes, as reflected from the title: Supplementation with cholecalciferol does not improve glycaemic control in diabetic subjects with normal serum 25- hydroxyvitamin D levels

Yes, because patients with poor glycemic control were randomly assigned to control and case group. Also appropriate dosages of Vit. D was used

Place of recruitment was not specified.

Patients were randomly assigned to both groups.

Variables were clearly defined.

Yes, the control group was randomly selected from the actual population

No blinding method used. Compliance was assessed by asking patients to return unused capsules.

Yes, they were: BMI, smoking status, waist to hip ratio, blood pressure, serum calcium, creatinine, lipid profile and 24 hr. urinary calcium.

Yes, because the method used was appropriate and acceptable

No, because of short…...

Diabetes and Vitamin D Studies
Evaluation Table

Clearly Focused Issue

Appropriate Method to Answer the Research Question

Acceptable Recruitment Methods

Acceptable Method of Selection of Controls

Minimization of Bias

Were the Confounders Accounted for in the Study Design

Are the Results Believable

Are They Applicable to Other Populations (Generalizable)

Do the Results Fit with Available Evidence

Witham et al., 2010

This is a follow-up study. The issue is whether patients with a vitamin D level of higher than 250 HD will gain a benefit from vitamin D supplementation.

A positive result is defined by reaching a level of 75 nmol or above. This is considered the level for optimum health.

Patients for the study were selected from general practice and diabetes specialty offices based on a positive type 2 diabetes mellitus diagnosis in accordance with the requirement set forth by the World Health Organization.

The group was divided into three sub-groups. The control had a placebo. The other two groups were given 100,000 IU and…...

Diabetes Intervention
As a complex metabolic disease, diabetes does not lend itself to a wide variety of interventions and concurring the disease does not appear to be an event that medicine will see in the near horizon. For these reasons, and because diabetes can be such a devastating disease, research that shows promise of positively impacting the course of the disease is greeted with enthusiasm by the medical community and the public.

Blood glucose levels must be strictly regulated in order to avoid the complications that diabetes can create. A substantive stumbling block is the difficulty of achieving consistent glycemic control without occurrences of hypoglycemia. Indeed, this factor is a primary obstacle to obtaining regulatory approval of an artificial pancreas. Earlier research has focused on automatic systems that monitor the levels of glucose and stop insulin flow when the blood glucose drops too low. While this is a viable approach, it can…...

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References

Progress in artificial pancreas development: preventing and treating low blood glucose. (2014, September 11). American Diabetes Association. ADA-Novo Nordisk Award in Hypoglycemia and Diabetes. Supported by Novo Nordisk Inc. Retreived from  http://www.diabetes.org/research-and-practice/we-are-research-leaders/recent-advances/progress-in-artificial-pancreas-development.html#sthash.HZwOqdlx.dpuf 

Russell, S.J., El-Khatib, F.H., Sinha, M., Magyar, K.L., McKeon, K., Goergen, L.G., Balliero, C., Hillard, M.A., Nathan, D.M., & Damiano, E.R. (2014, July 24). Outpatient glycemic control with a bionic pancreas in type 1 diabetes. New England Journal of Medicine. 371(4), 313-25. doi: 10.1056/NEJMoa1314474. Epub 2014 Jun 15.

Intervention for the Improvement of Hypoglycemic Control
Diabetes complication is one of the top health problems in the United States, and the ADA (American Diabetes Association) recommends that people suffering from diabetes should control their hypoglycemic and maintain A1C to < 7% to avoid diabetes complications. To achieve this objective, the "diabetes self-management education (DSME)"(Ni coll, aiser, Campbell, ET AL. 2014 p 207) is an effective tool to enhance hypoglycemic control and improve patients' outcomes. The DSME is an on-going educational process to facilitate the skill, knowledge, and ability of patients to carry out a diabetes self-care. I am a diabetic educator working in the diabetic outpatient clinical setting. My experience has made to understand that patients struggle to manage and control their diabetes after being educated because patients are not allowed to set their goals in order to manage their diabetes. (American Diabetes Association; 2013).

Objective of this paper is to…...

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Reference

American Diabetes Association (2013). Standards of medical care in diabetes -- 2013. Diabetes Care 36 (Suppl. 1):S11 -- S66, .

Funnell, M.M. Brown, T.L. Childs B.P. Et al. (2010). National Standards for Diabetes Self-Management Education. Diabetes Care. 33: 589-596.

Nicoll, K.G. Ramser, K.L. Campbell, et al. (2014).Sustainability of Improved Glycemic Control After Diabetes Self-Management Education. Diabetes Spectrum 27 (3): 207-211.

Norris, S.L., Lau, J., Smith, J.,et al. ( 2002). Susan Sundae, N.L Norris elf-Management Education for Adults with Type 2 Diabetes meta-analysis of the effect on hypoglycemic control.

The CDC has provided almost $7 million in funding to establish DPPs for research purposes, which means the number of pre-diabetes individuals helped by these programs will be very limited (CDC, 2012). While these programs will probably provide free or nearly-free diabetes preventive services to a large number of individuals, most underserved patients will not benefit from these programs.
S. 452 is worded in such a way that establishing DPPs under Medicaid will be optional for states (Sebelius, 2010). As of 2010, 43 states covered the expense of screening Medicaid patients for diabetes, but only 13 states provided reimbursement for obesity preventive services. This suggests that states are willing to pay for screening, but not preventive services like lifestyle interventions; however, if only a few states implement DPPs for Medicaid recipients, this will provide a proof-of-principle experiment in a real-world setting and establish the overall healthcare savings such programs can…...

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References

CDC (Centers for Disease Control and Prevention). (2012). National Diabetes Prevention Program. Funded Organizations. CDC.gov. Retrieved 17 Apr. 2013 from  http://www.cdc.gov/diabetes/prevention/foa/index.htm .

Civic Impulse, LLC. (2013). S. 452: Medicare Diabetes Prevention Act of 2013. GovTrack.U.S.. Retrieved 17 Apr. 2013 from  http://www.govtrack.us/congress/bills/113/s452 .

DPPRG (Diabetes Prevention Program Research Group). (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care, 26, 36-47.

Green, Lawrence W., Brancati, Frederick L., Albright, Ann, and PPDWG (Primary Prevention of Diabetes Working Group). (2012). Primary prevention of type 2 diabetes: Integrative public health and primary care opportunities, challenges and strategies. Family Practice, 29, i13-i23.

incidence of diabetic nephropathy, its etiology, its comorbidities, and how to control it. The best type of 'cure' is, as always, prevention, and close regulation of the disease which is particularly important since diabetic nephropathy can be fatal.
Diabetic nephropathy is the primary etiology of chronic kidney disease and kidney failure. Unfortunately, type 2 diabetes mellitus is skyrocketing in the United States alone to over 21 million cases, it is imperative for health care professionals to understand the mechanisms of diabetic nephropathy. This is particularly so since early recognition and prevention of the disease as well as tight serum glucose control can help prevent diabetic nephropathy from occurring thereby leading to potentially longer life for its carriers.

The authors describe the characteristics and etiology of diabetic nephropathy explaining how and why it can result in kidney disease and kidney failure.

Understanding these mechanisms can help us prevent kidney failure from occurring since…...

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My practice makes me in constant contact with patients who need to regulate their diabetes in order to prevent complications from occurring. Since patient compliance is irregular and challenging to achieve, and since the emotional and economic costs of diabetes -- as pointed out -- are huge -- it is my responsibility to attempt to help the patient as much as I can. Rather than feeling frustrated and helpless, the article shows me that I can do something: simply by being warm and caring. I can -- and do -- educate the patient on the complications of their disease. I can go beyond that in providing them with empathy, patience, and the time to listen to and refer them to available assistive agencies. In this wait, my practice extends far beyond the practical duties of nephrology. It lingers onto social work, counseling, and teacher. But, then again, these are the duties of the nurse who literally has to 'nurse' the patient back to health.

Source

Sego, Sherril (2007) Pathophysiology of Diabetic Nephropathy Nephrology Nursing Journal, 34(6), 631 -- 633

Problem Statement and Purpose of Study Self-care regimens that require a lot of input are necessary in making the study of diabetes effective. A lot of people with diabetes undergo distress. The diabetes distress is commonly described as the distress that arises from the effect of the diabetes symptoms, regimens for self management, the fear that there would be complications and functionality failure. The diabetes stress stabilizes after some time. It has been found that about a third of all diabetes type 2 patients are prone to diabetes stress regarded as clinically significant. Diabetes distress severely affects adult diabetic patients with a poor diabetes management plan. Such patients stand a high risk of diabetes-related complications. These developments are linked to poor glycemic control and self-management (Leeet al, 2018). The current research seeks to establish whether autonomy support by the health supporters of patients such as the members of their family…...

Glycogen Storage and Use
Exercise and diabetes: Beneficial effects

Diabetes is increasing in the United States and throughout the world due to the ever-growing adoption of an unhealthy lifestyle, including poor diet and lack of physical activity. Obesity is a characteristic often present in individuals with diabetes, and in order for the occurrences of diabetes to be reduced and the effects of diabetes to be minimized, efforts must be put in place to encourage weight loss and the maintenance of a healthy weight. It is expected that obesity and diabetes will reach epidemic proportions unless prompt action is taken to counteract these conditions (Albu & aja-Khan, 2003).

Lifestyle factors have been identified that are associated with glycemic control and body mass in individuals with diabetes. Grylls et al. (2003) found that reducing dietary saturated fat and excess body weight may be useful for improving glycemic control in older adults with diabetes. Moreover, a…...

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References

Albu, J. & Raja-Khan, N. (2003). The management of the obese diabetic patient. Primary Care, 30(2), 465-91.

Borghouts, L. & Keizer, H. (2000). Exercise and insulin sensitivity: A review. International Journal of Sports Medicine, 21(1), 1-12.

Casteneda, C., Layne, J., Munoz-Orians, L., Gordon, P., Walsmith, J., Foldvari, M., Roubenoff, R., Tucker, K., Nelson, M. (2002). A randomized controlled trial of resistance exercise training to improve glycemic control in older adults with type 2 diabetes. Diabetes Care, 25(12), 2335-41.

Cradock, S. (1997). The role of exercise in diabetes management. Community Nurse, 3(3), 23-4.

Improving Provider-Patient Communication Among LEP Patients Abstract
Elderly Hispanic patients experience numerous challenges when seeking for healthcare services since they are only eloquent in their native language and are classified as Limited English Proficient (LEP) patients. Language barriers contribute to poor provider-patient communication and necessitate the integration of third parties in the care delivery process. This paper whether the use of professional interpreters improves patient-provider communication and results in better health outcomes. Through a study that was carried out a sample of 40 elderly Hispanic diabetic patients at a Wellness Center in Los Angeles, using a professional interpreter improves provider-patient communication. The use of professional interpreters and language concordance is associated with improved provider-patient interactions, enhanced interpersonal care, and better medication adherence within three months.
Keywords: elderly Hispanics, patients, medication adherence, bilingual interpreters, treatment, patient-provider communication, healthcare providers.
Overview
Provider-patient communication is an important factor in enhancing patient outcomes in the modern healthcare environment. Elderly…...

Diabetes Management
Early Detection and Management of Diabetic Neuropathy in a Clinical and Homecare Setting

The objective of this study is to examine early detection and management of diabetic neuropathy in a clinical and homecare setting and specifically through examination of articles published after 2002. The information from each source will be summarized listing the strengths and weaknesses of each article in separate paragraphs. As well, this work will utilize table or graphs to present the findings.

O'eilly, Caryl Ann (2005) Managing the Care of Patients with Diabetes in the Home Care Setting, Diabetes Spectrum, July 2005. Vol. 18. No. 3. etrieved from: http://spectrum.diabetesjournals.org/content/18/3/162.full

The work of O'eilly (2005) reports that more patients than ever before are released earlier from hospitals and rehabilitation center and that those with diabetes are included in this trend. Diabetes is reported to be ranked second following congestive heart failure as the primary diagnosis at the time of entry…...

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References

Zieger, Anne (2009) Studies Offer Mixed Grades for Remote Diabetes Care. 6 July 2009 Retrieved from FierceHealthIT at:  http://www.fiercehealthit.com/story/studies-offer-mixed-grades-remote-diabetes-care/2009-07-06 

O'Reilly, Caryl Ann (2005) Managing the Care of Patients with Diabetes in the Home Care Setting, Diabetes Spectrum, July 2005. Vol. 18. No. 3. Retrieved from:  http://spectrum.diabetesjournals.org/content/18/3/162.full 

McLaughlin, Sue (2005) From Research to Practice/Diabetes Care in Special Settings: Meeting the Challenges: Diabetes Care in Special Settings Diabetes Spectrum July 2005 18:143-145. Retrieved from:  http://www.vnsny.org/research/projects/1_implemetation.html

However, what was once a slow journey has recently gathered momentum with the introduction of "more flexible immunosuppression protocols, the ability to individualize surgical options to patient needs, and the dramatic improvement of isolated islet transplantation results." (Allen, p. 3485) esearchers use pancreas transplant options and advanced surgical techniques, but the donor pancreas and surgical complications, as well as the type of immunosuppression affect the outcome of islet transplantation.
The immunosuppressive drugs have significant side effects and long-term effects are still not known. Known side effects of immunosuppressive drugs include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients also have experienced increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and cancer as well.

Progress on whole pancreas and beta cell transplantation has been hampered by the lack…...

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References

Allen, R.D.M., et al. (January-February 2000). Pancreas and islet transplantation: an unfinished journey. Transplantation Proceedings. Vol. 33. Nov-Dec 2001.

Clark, W.L. (January-February 2000). Beta cell replacement and islet transplantation. Diabetes Self-Management. Vol. 17(1): pp. 52, 54, 56.

Collazo-Clavel, M., ed.. (2001). Mayo Clinic on Managing Diabetes. Rochester, MN: Mayo Clinic.

Faustman, D. (December 2004). Towards a cure for type 1 diabetes (and other autoimmune diseases?). Infocus. 12(4): 1.

Diabetes
According to Waryasz & McDermott (2009), the global prevalence of diabetes among people aged between 20 and 79 rose to 6.4% affecting 285 million people in 2010 and the rate will rise to 7.7% affecting 439 million people by 2030. Amid 2010 and 2030, the rate of individuals with diabetes will increase by 69% in developing nations, and a twenty percent rate in developed nations. In 2011, the number rose to 366 and it is expected to rise to 552 by 2030. The pervasiveness of diabetes is advanced in males compared to females, yet the number of women with diabetes is more compared to that of men.

Diabetes affects any part of the human body and people with diabetes are likely to die of heart-related problems or stroke. Seventy-percent of individuals with diabetes show signs of high blood pressure which a risk factor for heart-related diseases. The majority of people with…...

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References

Boussageon R, Supper I, Bejan-Angoulvant T, Kellou N, Cucherat M, et al. (2012).Reappraisal of metformin efficacy in the treatment of type 2 diabetes: A meta-analysis of randomized controlled trials. PLoS Med, 9(4): e1001204. doi:10.1371/journal.pmed.1001204.

Karin et al.(2002). Diet and exercise among adults with type 2 diabetes: Findings from the Third National Health and Nutrition Examination Survey (NHANES III) . Diabetes Care, 25 (10), 1722-1728

Wang, H., & Yeh, M.(2012). Systematic to insulin therapy in adults with type 2 diabetes. Mixed- method systematic review. Journal of Advanced Nursing, 68(4), 743 -- 757. doi: 10.1111/j.1365-2648.2011.05853.x.

Waryasz, G., & McDermott, A. (2009). Exercise prescription and the patient with type 2 diabetes: A clinical approach to optimizing patient outcomes. Journal of the American Academy of Nurse Practitioners, 22, 217-227.

Type 2 Diabetes (T2D) in the U.S.
The development of Type 2 Diabetes (T2D) in the U.S. And developing countries

Type 2 diabetes was known previously as non-insulin-dependent diabetes. Unlike an individual with type 1 diabetes, a person with type 2 diabetic issues continues to produce insulin, but the individual's body fails to respond to it in a normal manner. Glucose cannot penetrate the cells and supply the required energy (it has been commonly referred to as insulin resistance). Eventually, the blood sugar levels rise and make the pancreas produce additional blood vessels insulin. In the end, the pancreas wears out because of overworking to generate surplus insulin and eventually becomes unable to generate adequate insulin to keep blood vessels sugar levels normal. Individuals with insulin resistance may or may not develop type 2 diabetic issues (Atta-ur-ahman, eitz & Choudhary, 2010). This is independent of the pancreas' ability to generate adequate insulin…...

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References

Atta-ur-Rahman, Reitz, A.B., & Choudhary, M.I. (2010). Frontiers in Medicinal Chemistry Volume 1. Sharjah: Bentham Science Publishers.

Ginsburg, G.S., & Willard, H.F. (2013). Genomic and personalized medicine. London: Academic.

Kalhan, S.C., Prentice, A. & Yajnik, C.S. (2009). Emerging societies: Coexistence of childhood malnutrition and obesity. Basel, Switzerland: Karger.

Kumar, D. (2012). Genomics and health in the developing world. Oxford: Oxford University Press.

Drugs thought to enhance serotonin-mediated neurotransmission have been shown to diminish appetite for carbohydrates. In a study done by Heraief, Burckhardt, Wurtman and Wurtman, (1985), they examined the ability of tryptophan (TP), serotonin's amino acid precursor, or a placebo to influence weight loss among 62 obese Swiss outpatients who were on a reducing diet known as the Protein-Sparing Modified Fast (PSMF) Diet which is often associated with severe carbohydrate craving. This diet provided relatively large amounts of protein but little carbohydrates, thus stimulating ketone body production. Its consumption also reduced the ratio of plasma TP to the summed concentrations of the other large neutral amino acids, thereby probably diminishing brain TP and serotonin levels. It was found that among moderately obese patients the TP significantly enhanced weight loss, especially during the first treatment month but also during the total. The TP didn't modify the reported adherence to the PSMF diet.…...

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References

Gordon-Elliott, Janna S. And Margolese, Howard C. (2006). Weight loss during prolonged branched-chain amino acid treatment for tardive dyskinesia in a patient with schizophrenia. Australian & New Zealand Journal of Psychiatry. 40(2), p195-195.

Group, Edward F. (2009). Amino Acid Weight Loss. Retrieved March 12, 2010, from Weight

Loss & Obesity Web site: http://www.weightlossobesity.com/weight-loss/amino-acid-weight-loss.html

Heraief, Eric, Burckhardt, Peter, Wurtman, Judith J. And Wurtman, Richard J. (1985).

The structure of yetta is similar to that of GLP-1 and performs the same functions. oth promote decreased appetite (Wilson).
Dr. Wysham was an observer at a study conducted on 20 Rockwood diabetic patients who were taking conventional diabetic medication for their uncontrolled blood sugar (Wilson 2005). She was not informed about their glucose levels for several months after the tests began. About two-thirds of the respondents were given different injectible doses of yetta to incorporate into their medication plan, while the rest were given placebos. All of them were instructed and trained to do the injections at certain times twice daily for a month. Then they were subjected to a physical exam. Dr. Wysham closely monitored their liver, kidney, blood counts, and other functions. She observed that the patients consistently lose weight while taking yetta. The average respondent-patient lost 15 pounds in the duration of the study, 5 lost…...

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Bibliography

Business Editors (2005). Understand the impact of regulatory reform and raised drug

Safety awareness on off-label drug use. 2 pages. Business Wire: Gale Group

2007). Januvia approved in the European Union for the treatment of type-2 diabetes. 4 pages.

2007). Late breaking data released at ADA showed that the investigational use of Januvia and Metformin as initial combination therapy provided significant glucose lowering efficacy over 54 weeks in patients with type 2 diabetes. 8