Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals

1.0 Introduction

In the recent past, there have been so many cases of diabetes and about 9% of the world has had problems dealing with this disease. Diabetes has affected both the developed and the developing world while the women become the most affected individuals. The western lifestyle has been so much been blamed for the high occurrence of this disease. This includes the type of food that people eat and failure to get involved in physical activities. This paper will look at a research done that follows the guidelines of evidence-based practice in managing diabetes through physical activity and proper diet. It will also look at the importance of the evidence based practice and how it is of help to patients and physicians. The barriers that also challenge the practice will also be outlined.

2.0 Evidence-Based Practice

Evidence-based practice is the use of the best researched proven medicine and assessments in health care and providing service to patients (Baker, and Tickle-Degnen, 2014, P.400).This is a practice that uses evidence-based medicine by integrating it in clinical expertise from the best systematic research. The practice makes that the clinicians are able to stay in touch with the researched literature which they use in making a decision while treating patients. The clinician has to share this research with his or her clients so that the client will decide on the best methods to choose from a variety. Clinicians have to record the methods that they use to treat patients and also the evidence so that they are accountable for their own actions in case of problems arising.As a clinician using EBP helps in giving the best services to the clients due to the incoming practices that are easily affordable and effective.

For clinicians evaluating all evidence will be nerve racking and time consuming and therefore the need for the group to help them discuss this research seems to serve them better. The EBP used has to be in line with the needs, values, and preferences of the clients (Liamputtong, 2013, p.102).EBP seeks to serve the following needs: It questions the scientific experiment used in a certain problem, it observes and analyses the description used, it also records the evidence of systematic retrieving (Rynes, et.al, 210, 2014). EBP not only relies on the decisions of the evidence provided but also seeks to incorporate the characteristics of the patients involved. The technicians have to use techniques that are best according to the research.

This is because some therapy methods work better than others.In their work clinicians have to take procedures so that they ensure that they are in line with the EBP guidelines. The first thing that they will do is to formulate a clinical question, search the literature sort and critique the literature. They will then come up with the recommendations according to their research which they implement and document them. This is done through applying them through their clients by treating and also consulting them on what serves them best and what will help them from their problems. The final process is through sharing the results of the EBP used with others through writing.

3.0 Research on Diet and physical activity on type 2 diabetes

Diet and physical activity in patients with type 2 diabetes have proven a great problem but through proper management, it has given an easier time to health professionals and patients. After holding several focus groups with patients with type 2 diabetes, discussions were held focusing on management of the disease, barriers, and facilitators. This included focusing on changes in diet and physical activity. Findings of the groups were later recorded. The finding helped in better understanding of those diagnosed with type 2 diabetes and also the clinicians (Sten’f, pg. 375, 2013).

Research on patients’ behavior regarding their diet and physical activities was carried out. Questionnaire forms were issued to patients so that they could indicate the number of days that they were involved in any exercise. Those who engaged in physical activity more had better results and management of type 2 diabetes. Participants performed 30 minutes of activity for about 4 days a week

Dietary advice was given to sensitize the patients and create awareness on the benefits of eating healthy food. The food should be readily available to the general population which they do not have to struggle while attaining it. The food should also be in line with the patient beliefs, culture, and their needs. Patients should be sensitized to change from their poor methods of feeding to better ones which will improve their health at large (Salas-SalvadГі, et.al, p. 15, 2011).

The decrease of the type 2 diabetes incidences in the Mediterranean diet implies that the diet should be well balanced with high fiber, carbohydrates with low glycemic indexes like whole grains, vegetables, fruits. Additionally, low-fat dairy products should be encouraged while the intake of foods which have saturated and trans-fatty acids be controlled and be kept at minimum levels.The risk of hypoglycemia will also be reduced when using insulin (Booth, p. 293, 2013). Meal patterns in patients should be consistent and not jumped. Alcohol intake in patients should also be discouraged. Excess energy intake through carbohydrates should be minimized, although sucrose containing foods can substitute carbohydrates.

Marketed foods for people with diabetes should also be discouraged. In case these patients are admitted in a hospital meal planning should be implemented so as to ensure that they do not lack the consistency of carbohydrates in their meals or snacks.

For adults who are obese with a BMI of more than 30, it is recommended that there should be referred to structured behavioral interventions that aim at losing weight because of the high risk that they are exposed to due to their weight. It is also recommended that the patients be involved in the physical activity which will get them actively involved. The physical activities that can be done range from moderate to highly intensive one. When a patient is involved in any type of physical activity it helps in improving the blood glucose in the body. This helps prevent the mortality rate of these patients due to the benefit that physical activity gives the body. The insulin levels are greatly improved with exercise through aerobic activity and resistance training. Physical activity ensures that fuel is used through the coordination of the endocrine and nervous system (Umpierre, Ribeiro, et.al, pg. 1795, 2011).

When someone exercises, fuel used causes predominance reliance of the free fatty acids that are resting to blend to fat, glucose and then to muscle glycogen. The more the exercise the more the reliance of carbohydrates as long as they are enough amounts in muscle and blood. When the glycogen levels become low, the muscles will increase the uptake and use the circulating blood glucose with the free fatty acids that tissues release.Aerobic exercise improves the blood glucose levels while resistance exercise results in lower fasting blood glucose for 24 hours after the exercise. Physical activity in patients is very important and they should, therefore, choose those that involve the whole body and the duration should also be increased. Physical activity uses carbohydrates and also fat utilization is also increased (Colberg, et.al, p. 155, 2010).

Type 2 diabetes is associated with a decrease in oxidation of lipids  utilization of the fats will lead to improvement in the condition of the disease.Type 2 diabetes has also been caused by obesity. To avoid obesity in patients, weight loss must be achieved so that they do not have big bodies that will affect their health. Body weight cannot solely depend on physical activity  it also includes other factors like diet and modification of behavior. This means that type 2 diabetes patients have to be very vigilant of the food that they eat and aim at eating fit. Patients watching what they eat after being diagnosed with type 2 diabetes matters a lot since it helps control glucose levels. The diabetic diet revolves around carbs, fat, fiber, and salt. Diabetes comes with complications of hearts diseases and it is therefore important to avoid fatty diets that contribute to this. Saturated and Trans fats should be avoided at all costs.

The fats are found in foods like baked foods, milk, beef, and cheese. It is, therefore, wiser to concentrate on foods like lean meat, eating boiled, roasted, or baked food, low-fat dairy products, and use of vegetable oils (Carter, Gray, et.al, p. 341, 2010)Carbs are the foods that drive a body by giving it fuel thus affect the blood sugar by a great level. These include foods like potatoes, corn, and fruits, grains and sugars. The complex carbohydrates are the best since they take the time to be digested and therefore give steady fiber and energy to the body. It is therefore wise to control the carbohydrates that get in our bodies so that the insulin levels do not go up or fall rapidly (Elhayany, et.al, p. 206, 2010). Too much salt causes heart disease and therefore should be limited. It is important to avoid seasoned and flavored foods, any canned foods, and processed foods so as to avoid this risk. Fresh ingredients should at all times be encouraged for type 2 diabetes patients (Tahrani, et.al, p. 193, 2011).

3.1 Barriers

The biggest barriers that prove to be blocking this research are diet. People find it hard to control the food they eat especially where there is only one patient involved in a family setting. Most of the patient’s report shows the lack of discipline in what they eat due to the presence of other foods that are cooked in a family. It also becomes tricky for patients who travel a lot and are not able to control the amount of processed foods that they eat. It is hard to come across outlets that offer these kinds of foods recommended for these patients (Rapp, et.al, p. 114, 2010).While doing this research I also experienced problems with the research. Physical activity has also been a problem for patients especially when they are overcome by this disease. It seems almost impossible for them to engage in physical activity. The nature of work that these patients engage in also matters a lot. This is because, with the technology advancement some of the work does not need a lot of movement and therefore face the challenge of exercising (Majid, et.al, p. 65, 2011).

Physicians also face challenges while dealing with patients. Most of the times, patients do not follow the given instructions (Solomons, and Spross, p. 111, 2011). This pushes them back making them start afresh. Others are forgetful especially the older adults who even skip up doses of medication.Education has also posed a major problem due to the difference in the age whereby people who learned a long time were not able to learn of EBP approach to take care of patients. There is, therefore, consumption of time in trying to teach on how to do research.

3.2 My take on this domainI chose this domain of type 2 diabetes due to the problems that I have seen with patients trying to cope with the disease. If an action by these patients is taken on managing this disease this could avoid the risks that are involved with it. The disease has been a menace to the world with patients even dying at an early age. These practices of watching diet and physical activity are very important for preventing this disease. I feel that it is also easier to prevent a disease than treating it.

My research has also chosen simple tactics that can be afforded by both physicians and patients in managing the disease. It is much easier to diet on the foods mentioned since they are easily afforded. The only thing that matters most is the discipline that the patients have in observing what they eat,This research can be relied on due to the benefits that it has in managing type 2 diabetes. Through proper management, it can reduce the mortality rates of patients and also reduce the risks that are involved with diabetes. [bookmark: _GoBack]

4.0 Conclusion

Evidence-based practices have been proven to successful in delivering services to patients and in the nursing department. Following guidelines of this practice, it is, therefore, easier for a research done in the same way to be of help. The research and study are aimed to help the nursing fraternity in treating patients well and guiding them in the practices of dealing with type 2 diabetes. If taken into consideration this research can be of much importance in helping patients deal with it and also enable them to prolong their life. It will also enable physicians to deal with lighter cases and thereby making the services better. The society will also benefit as a whole since funds directed at dealing with complicated cases will be directed elsewhere.

In addition, the research was accompanied by various technicalities especially when dealing with the patients. This included that most of the patients fail to follow the given instructions thus making it for their self-management both in diet and physical activity. However, nurses can take my research simple tactics in managing the patients affected by the disease bearing in mind that it is much easier to diet on the foods mentioned since they are easily afforded. In addition, patients should be disciplined and observe what they eat.

5.0 References

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