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PICOT research question

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Date
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PICOT question

Do type 2 diabetics (P) in underserved communities get better glycemic control (O) with DASH

diet as the primary treatment (I) than those who get drug therapy as a primary treatment (C)

within six months.

PICOT Table

P People with type 2 diabetes in underserved communities are at a higher risk of

developing other comorbidities and mortality as compared to the rest of the population.

Among those affected, it is more probable that low-income individuals with limited

health literacy may be diagnosed due to contextual variables such as scheduling issues

(Philis-Tsimikas, 2019). For low-income persons with limited health literacy, a lack of

proper food, health care, and resources increased their likelihood of diagnosis. Type 2

diabetes is more prevalent in racial/ethnic minorities than non-Hispanic whites

(AuYoung et al., 2019). Self-management of diabetes is difficult for the poor. The

disadvantaged group's managerial capacity will always be an issue. Without enough

education, individuals would struggle to maintain control of their condition. Due to a

lack of educational opportunities, people are forced to self-educate, sometimes

inaccessible or too expensive for the poor.

I Dash diet as primary treatment

The DASH diet was developed to assist in naturally lowering blood pressure. It has

been proven that diet meals provide a high concentration of potassium, calcium,

magnesium, among other needed nutrients in the body. Dash diet recommends a low

intake of saturated fats, sodium, and cholesterol. This is because these kinds of foods

increase the risk of heart rate and glucose levels in the body. The diet also recommends
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an intake of whole grains, vegetables, poultry, fish, nuts, and fruits. Leans meats,

sweets, and tropical oils should be consumed in moderation or avoided.

Campbell (2017) insists on the benefits of the DASH diet for people living with

diabetes. The author acknowledges that people with diabetes can also suffer from high

blood pressure, and therefore, the DASH diet is suited for this kind of population.

Diabetes educators discuss the meal plans with the patients to guide them to adopt the

plan without difficulties. This diet may benefit people who suffer from hypertension,

insulin resistance, hyperlipidemia, and obesity. Diabetes patients are more likely than

non-diabetics to develop hypertension (Chiavaroli et al., 2018). Treatment and

prevention of hypertension must be emphasized in people with diabetes.

C Drug therapy for diabetes

The following medications are the most frequently prescribed: biguanides, acarbose

(Metformin), and injectable drugs (including exenatide, mitiglinide, pramlintide,

sitagliptin, and saxagliptin). Thiazolidinediones include glyburide, glimepiride, and

tolazamide (such as rosiglitazone and pioglitazone) (Philis-Tsimikas, 2019). Because

rosiglitazone may increase your risk of developing cardiac problems, discuss any

concerns you have with your doctor before starting this medication. These drugs may

be used alone or in conjunction with insulin. If you have difficulty controlling your

blood glucose, you may require insulin. It is injected via a syringe or insulin pen into

the skin. Insulin cannot be taken orally. Women with type 2 diabetes who become

pregnant and breastfeed may be switched to insulin due to the lack of evidence that oral

hyperglycemia medications are safe during pregnancy (Philis-Tsimikas, 2019). After

years of therapy, diet and exercise are effective for only 20% of adults. Eventually,
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most adults will require oral medications and insulin. Drug therapy may be necessary

to maintain a healthy blood glucose level and avoid microvascular problems.

Adolescents with type 2 diabetes confront numerous age-specific hurdles to oral

medication usage. Avoiding alcohol and other dangerous behaviors that interfere with

pill administration, as well as social stigma and sickness denial, are all examples of

this. Adolescents may have difficulty appreciating the importance of long-term

treatment. All oral medicines are now prohibited during pregnancy, and adolescents are

a particularly high-risk category. Historically, these medications were used by women

who had reached the end of their reproductive years.

O Glycemic control

Glycemic management is crucial for avoiding long-term complications of diabetes.

Individuals with less education and those who live in deprived regions have less

control over their blood sugar (American Diabetes Association, 2020). Rural residents

are more likely to have inadequate knowledge, self-management behaviors, self-

efficacy, and continuity of care about type 2 diabetes. In addition, a lack of education

increases the likelihood of being in a lower socioeconomic class, limiting access to

adequate health care. Due to limited availability and affordability, individuals may wait

until complications occur before seeing a diabetic expert. Individuals with a higher

level of education and those who live in privileged areas are more likely to be able to

afford proper treatment and management. Optimal glycemic control requires a healthy

lifestyle that includes frequent physical activity and healthy eating habits. There is no

doubt that poor glycemic control is associated with unhealthy eating habits.

Undeserved individuals suffer from a lack of understanding about healthy diets or the
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high cost of healthy foods. Active and personalized education is critical to motivating

people to eat healthy, exercise, and visit their doctor regularly.

T Within six months

Diabetes is a chronic disease meaning that it has no cure. However, it can be managed

through medication, a healthy diet, and exercise. DASH diet has been scientifically

proven to produce results as soon as one month after its incorporation. The diet helps

patients with glycemic control, weight loss, and staying healthy. The purpose is to

continuously adapt the DASH diet for six months to test whether it is more effective in

glycemic control than pharmacological therapy. Past studies have shown that diet and

exercise play a huge role in treating Type 2 diabetes. If patients can keep their weight

and glucose levels in check, it is possible to manage diabetes without medication.

However, it is always recommended to visit the physician regularly to advise them on

the best approach to adopt to avoid any complications. Self-diagnosis of the DASH diet

or other holistic medicine is discouraged for type-2 diabetes patients.

References

American Diabetes Association (2020). Obesity Management for the Treatment of Type 2

Diabetes: Standards of Medical Care in Diabetes—2021. 44(Supplement 1), S100-S110.

https://doi.org/10.2337/dc21-s008

AuYoung, M., Moin, T., Richardson, C., & Damschroder, L. (2019). The Diabetes Prevention

Program for Underserved Populations: A Brief Review of Strategies in the Real

World. Diabetes Spectrum, 32(4), 312-317. https://doi.org/10.2337/ds19-0007

Campbell, A. (2017). DASH Eating Plan: An Eating Pattern for Diabetes Management.

Diabetes Spectrum, 30(2), 76-81. DOI: 10.2337/ds16-0084

Philis-Tsimikas, A. (2019). Innovative Solutions to Care for Individuals with Diabetes in

Underserved Populations. Diabetes Spectrum, 32(4), 291-292.

https://doi.org/10.2337/ds19-0034