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PICO(T) questions are valuable when developing research questions for treating chronic diseases. While the T refers to the Time or Type of Study, PICO stands for Population, Intervention, Comparison, and Outcome. Clinicians and researchers may develop targeted and resolvable study questions by specifying these components. A PICO(T) structure may guarantee that the research question is precise, pertinent, and capable of being answered with the data at hand. Evaluation of the research data and clinical knowledge are critical components of an evidence-based strategy for managing chronic diseases. Clinicians may better the outcomes of their patients by incorporating the best available evidence into their practice via the use of PICO(T) questions and other tools (McClinton, 2022).

Exploration of Practice Issue

Millions of individuals across the globe struggle with the chronic illness known as type-2 diabetes (Divers et al., 2020). Since it is a progressive condition, lifetime treatment is necessary to avoid consequences, including cardiovascular disease, renal disease, and blindness. Even though there are many different treatment choices, many people with type 2 diabetes find it difficult to attain and maintain sufficient glycemic control. Poor glycemic management may result in a high cost to individuals, families, and the healthcare system since it can cause severe morbidity and death (Jia et al., 2019).

Healthcare professionals have considerable difficulty regarding the practical issue of patients with hyperglycemia having insufficient glucose control despite current therapy techniques. 

PICO(T) Question

In adults with hyperglucemua (P), does the addition of telemedicine-based self-management training and assistance (I) compared to usual care (C) improve HbA1c levels (O) over 12 months (T)?

Population (P)

Adults with hyperglycemia 

Intervention (I)

Telemedicine-based self-management education and support 

Comparison (C)

Usual care 

Outcome (O)

Improvement in HbA1c levels 

Time (T)

12-month period

This problem emphasizes recognizing and removing obstacles to efficient diabetes care. In order to create tailored therapies that may improve diabetes outcomes, it is critical to comprehend the variables that lead to poor glycemic control, including patient factors, healthcare system factors, and treatment-related factors. Patients may attain and maintain optimal glycemic control using an evidence-based strategy incorporating patient education, lifestyle changes, and medication management, improving their health quality (Pivari et al., 2019).

Benefits of the PICO(T) Approach

A PICO(T) method will be beneficial in examining the practical problem of poor glycemic management among hyperglycemic patients. By defining essential components of the question, the PICO(T) framework aids in formulating focused and responsive research questions. This method enables academics and medical professionals to create research questions that are precise, pertinent, and based on data that is already accessible. By using this strategy, it will be possible to make sure that the research topic is precise and that the study is planned to address the relevant problem (McClinton, 2022).

Sources of Evidence

Several potential sources of evidence could effectively answer the PICO(T) issue about including telemedicine-based self-management training and assistance to enhance glucose control. Randomized controlled studies (RCTs) contrasting the efficacy of telemedicine-based self-management education and assistance with standard treatment in patients are one possible source of evidence. These studies may provide light on the efficacy of telemedicine-based therapies for improving glycemic control and highlight any potential advantages or disadvantages of this strategy (Zhang et al., 2022).

Systematic reviews and meta-analyses examining the effectiveness of telemedicine-based therapies for improving diabetes are other possible sources of proof. These studies could summarize the current data, point out knowledge gaps, and identify areas that need further investigation. Furthermore, observational and cohort studies may provide light on the clinical practice’s efficacy of telemedicine-based therapies, including the influence on patient outcomes and healthcare spending (Vounzoulaki et al., 2020).

Rationale

Several factors or rationales may be considered when deciding if a research or piece of data can answer a PICO(T) issue. First, the population, intervention, comparison, outcome, and period specified by the PICO(T) question should be the specific focus of the research or evidence. High-quality research or evidence should also use suitable data-gathering and analysis techniques and strict study designs (Yusra & Waluyo, 2022).

Additionally, considerations like patient characteristics, comorbidities, and the accessibility of resources like technology or skilled employees should be considered when determining the study’s or evidence’s applicability in a clinical setting. The research or supporting data should also be fresh and current, reflecting the most recent findings and recommended strategies for managing diabetes (Eberle & Stichling, 2021). Finally, it is essential to assess any possible conflicts of interest, restrictions on the research design or the data collection, and the possibility that unmeasured or unidentified variables may influence the outcomes. Researchers and clinicians may choose the best sources of information to address PICO(T) issues and create an evidence-based strategy for diabetes care by considering these criteria and justifications (Artasensi et al., 2020).

Findings from Sources of Evidence

Randomized controlled trials and meta-analyses, observational studies, and cohort trials are relevant sources of information that may help with the healthcare problem of insufficient sugar control in individuals with hyperglycemia (Xie et al., 2020).

In a research conducted by Tefera et al. (2020), hyperglycemic patients visiting the outpatient clinic in Ethiopia were evaluated for their health literacy on diabetes and its relationship to glycemic management. According to the research, patients with increased levels of diabetes literacy were 2 times more probable than patients with lower diabetes literacy to accomplish their desired diabetes level. Additionally, individuals with high adherence were 1.61 times more likely than patients with a poor commitment to attain the desired glycemic control. Conversely, diabetes individuals with morbidity had a 67% lower chance of achieving the desired level of glycemic control (Tefera et al., 2020).

In the second study, Hurst et al. (2020) examined how Thais with type 2 diabetes mellitus related their knowledge and self-monitoring to diabetes control. According to the research, among Thai people with Type 2 diabetes, blood glucose control was significantly correlated with diabetes management self-efficacy. 

Credibility of Resources

The CRAAP test is a valuable technique for determining a source’s reliability. Currency, Relevance, Authority, Accuracy, and Purpose are the acronyms for CRAAP. The two studies being discussed were published in peer-reviewed publications, demonstrating that they underwent in-depth evaluation by subject-matter experts. They also provide a complete account of their approach to evaluate the correctness of their conclusions. Additionally, both studies are current, one was published in 2020 and the other in 2019, indicates their relevance (Tefera et al., 2020). The reliability of the sources, however, can be called into doubt since the studies were limited to a particular area and might not generalize to other groups. However, the research’s credibility is increased by including recognized psychometric tools, such as the Morisky Green Levine Scale and thorough 15-item questionnaires on diabetes health literacy. Despite significant limitations, the research passes the test for a reliable data source (Hurst et al., 2020).

Relevance of Findings

The two discussed studies provide essential light on the connections between type 2 diabetes patients’ health literacy and glycemic control. Since patients with more significant health literacy levels are more probable to attain the desired glycemic control, the first research carried out in Ethiopia emphasizes the critical relationship between diabetes health literacy and glycemic control (Tefera et al., 2020). The second Thai research that is most relevant showed that diabetes management in people with type 2 diabetes is closely related to diabetes management self-efficacy (Hurst et al., 2020). The results of both trials have significant implications for the PICO(T) topic of how to enhance glycemic control in type 2 diabetic patients. They contend that glycemic control may benefit from treatments that improve health literacy, adherence, and self-efficacy. The strongest correlation between blood glucose control and diabetes management self-efficacy in the Thai population is the most critical result. It indicates that treatments focused on enhancing self-efficacy may significantly influence diabetes self-management and glycemic control (Kusuma et al., 2022).

Conclusion NURS FPX 4030 Assessnent 3 PICO(T) Questions and an Evidence-Based Approach

Overall, the results of both trials point to the possibility that patient education, self-management abilities, and self-efficacy treatments might enhance glycemic control and lessen the likelihood of complications from chronic diabetes. These programs have to emphasize not just raising patients’ awareness of diabetes but also increasing their sense of self-efficacy and medication adherence. In order to enhance patient outcomes, healthcare professionals and politicians should consider these results when making choices on diabetes treatment.

References

Artasensi, A., Pedretti, A., Vistoli, G., & Fumagalli, L. (2020). Type 2 diabetes mellitus: A review of multi-target drugs. Molecules25(8)https://doi.org/10.3390/molecules25081987 

Divers, J., Mayer-Davis, E. J., Lawrence, J. M., Isom, S., Dabelea, D., Dolan, L., Imperatore, G., Marcovina, S., Pettitt, D. J., Pihoker, C., Hamman, R. F., Saydah, S., & Wagenknecht, L. E. (2020). Trends in incidence of type 1 and type 2 diabetes among youths — Selected counties and Indian reservations, United States, 2002–2015. MMWR. Morbidity and Mortality Weekly Report69(6), 161–165. https://doi.org/10.15585/mmwr.mm6906a3 

Eberle, C., & Stichling, S. (2021). Clinical improvements by telemedicine interventions managing type 1 and type 2 diabetes: Systematic meta-review. Journal of Medical Internet Research23(2)https://doi.org/10.2196/23244 

Hurst, C. P., Rakkapao, N., & Hay, K. (2020). Impact of diabetes self-management, diabetes management self-efficacy, and diabetes knowledge on glycemic control in people with Type 2 Diabetes (T2D): A multi-center study in Thailand. Plos One15(12), e0244692. https://doi.org/10.1371/journal.pone.0244692 

Jia, W., Weng, J., Zhu, D., Ji, L., Lu, J., Zhou, Z., Zou, D., Guo, L., Ji, Q., Chen, L., Chen, L., Dou, J., Guo, X., Kuang, H., Li, L., Li, Q., Li, X., Liu, J., Ran, X., & Shi, L. (2019). Standards of medical care for type 2 diabetes in China 2019. Diabetes/Metabolism Research and Reviews35(6). https://doi.org/10.1002/dmrr.3158 

Kusuma, C. F., Aristawidya, L., Susanti, C. P., & Kautsar, A. P. (2022). A review of the effectiveness of telemedicine in glycemic control in diabetes mellitus patients. Medicine101(48)https://doi.org/10.1097/md.0000000000032028 

McClinton, T. D. (2022). A guided search: Formulating a PICOT from assigned areas of inquiry. Worldviews on Evidence-Based Nursing19(5). https://doi.org/10.1111/wvn.12598 

Pivari, F., Mingione, A., Brasacchio, C., & Soldati, L. (2019). Curcumin and type 2 diabetes mellitus: Prevention and treatment. Nutrients11(8)https://doi.org/10.3390/nu11081837 

Tefera, Y. G., Gebresillassie, B. M., Emiru, Y. K., Yilma, R., Hafiz, F., Akalu, H., & Ayele, A. A. (2020). Diabetic health literacy and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of a university hospital in Ethiopia. Plos One15(4)https://doi.org/10.1371/journal.pone.0231291 

Vounzoulaki, E., Khunti, K., Abner, S. C., Tan, B. K., Davies, M. J., & Gillies, C. L. (2020). Progression to type 2 diabetes in women with a known history of gestational diabetes: Systematic review and meta-analysis. The BMJ369https://doi.org/10.1136/bmj.m1361 

Xie, W., Dai, P., Qin, Y., Wu, M., Yang, B., & Yu, X. (2020). Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis. BMC Pregnancy and Childbirth20(1). https://doi.org/10.1186/s12884-020-02892-1 

Yusra, A., & Waluyo, A. (2022). Family support toward adherence and glycemic control of type 2 diabetes patient: A systematic review. Problems of Endocrine Pathology79(1), 100–111. https://doi.org/10.21856/j-pep.2022.1.14 

Zhang, A., Wang, J., Wan, X., Zhang, Z., Zhao, S., Guo, Z., & Wang, C. (2022). A meta-analysis of the effectiveness of telemedicine in glycemic management among patients with type 2 diabetes in primary care. International Journal of Environmental Research and Public Health19(7), 4173. https://doi.org/10.3390/ijerph19074173 

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