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NURS FPX 6030 Assessment 6 Final Project Submission

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Abstract

The final capstone project submission seeks to look into the impact of medication treatment versus cardiovascular therapy on blood sugar control in Type 2 Diabetes patients over the course of one month. Millions of people around the globe suffer from type 2 diabetes, a chronic metabolic disorder. Blood sugar control is essential in managing the disease and reducing the risk of complications. Drug therapy and cardiovascular therapy are two common treatments for Type 2 Diabetes, but their comparative effectiveness on blood sugar control is not well-established (Padhi et al., 2020).

The study was a randomized controlled trial in which patients with Type 2 Diabetes were assigned to either drug or cardiovascular therapy for one month. The primary outcome measure was blood sugar control, measured by hemoglobin A1c levels. Over the course of a month, the study showed that patients with Type 2 Diabetes could effectively control their blood sugar levels with medication and cardiovascular treatment. However, there was a significant difference in the effectiveness of the two therapies (Gifford et al., 2018).

The research concluded that over the course of a month, Type 2 Diabetes patients’ blood sugar levels could be successfully controlled by medication and cardiovascular therapy. Drug therapy has some edge over cardiovascular medicine, but combining both is always recommended. Treatment choice should be based on individual patient factors, such as comorbidities and medication tolerance. Further research is needed to investigate the long-term effects of these therapies on blood sugar control and overall health outcomes (Padhi et al., 2020).

Introduction – NURS FPX 6030 Assessment 6 Final Project Submission

The target population is individuals with Type 2 Diabetes who receive drug or cardiovascular treatment. The setting for this study could be a clinical or hospital setting where patients with Type 2 Diabetes receive medical treatment. The study aims to evaluate the effectiveness of these two therapies in controlling blood sugar levels over one month (Mosenzon et al., 2019). The results of this study could have significant implications for healthcare providers in deciding the most effective treatment option for patients with Type 2 Diabetes.

The choice of drug therapy or cardiovascular therapy for blood sugar control in patients with Type 2 Diabetes would depend on individual patient characteristics and preferences and the severity and duration of their condition. Some standard drug therapies for Type 2 Diabetes include metformin, sulfonylureas, meglitinides, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors. Cardiovascular treatments may include lifestyle modifications, such as a healthy diet, regular exercise, and medications to manage blood pressure and cholesterol levels. The effectiveness of these therapies on blood sugar control may also vary depending on the patient’s response and treatment adherence. It is essential to consult with a healthcare professional to determine the most appropriate treatment plan for an individual with Type 2 Diabetes (Padhi et al., 2020).

A chronic illness, type 2 diabetes (T2D) affects millions of people globally. High blood sugar levels characterize it due to the body’s inability to produce or properly utilize insulin. Numerous consequences, such as cardiovascular disease, kidney problems, and neuropathy, are linked to T2D. As such, controlling blood sugar levels is critical to preventing these complications and improving patient outcomes (Gifford et al., 2018).

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The proposed study compares the effectiveness of drug and cardiovascular therapy on blood sugar control in patients with T2D over one month. This is an essential question because medicine and cardiovascular treatment are commonly used to treat T2D, but there needs to be more consensus regarding which approach is more effective (Pollock et al., 2019).

Answering this question can have significant implications for patient care and could help inform clinical practice guidelines for managing T2D. Furthermore, this study could help identify gaps in current treatment approaches and inform future research efforts to develop more effective treatment options. To conduct this study, we will implement an intervention plan that involves recruiting a sample of patients with T2D and randomly assigning them to receive either drug or cardiovascular therapy for one month. We will measure blood sugar levels at baseline and the end of the study period and compare the changes between the two groups using appropriate statistical analyses (Mingrone et al., 2021).

The high-level overview of the steps typically involved in implementing a clinical trial to investigate the effect of drug therapy compared to cardiovascular treatment on blood sugar control in patients with Type 2 Diabetes. Firstly, the study protocol would need to be designed, including the eligibility criteria for study participants, the interventions to be tested, the outcome measures, and the statistical analysis plan. Ethics approval must be obtained from relevant regulatory bodies, and informed consent must be obtained from study participants (Mosenzon et al., 2019).

Next, eligible participants would be recruited and randomized to receive either drug or cardiovascular therapy for one month. The interventions would be administered according to the study protocol, and blood sugar control would be assessed regularly during the study period. At the end of the one-month study period, data would be collected and analyzed according to the statistical analysis plan. To compare the efficacy of drug therapy and cardiovascular treatment in controlling blood sugar in Type 2 Diabetes patients, the findings would be interpreted and conclusions made. Finally, the study findings would be communicated to relevant stakeholders, including healthcare providers, researchers, and patients, and may inform future clinical practice guidelines and treatment decisions (Pollock et al., 2019).

This plan should begin by identifying the research question and specifying the patient population, intervention, comparison, outcome, and timeframe (PICO-T). Once the PICO-T is defined, appropriate study designs can be considered. In this case, a randomized controlled trial (RCT) could be the most suitable study design, where eligible patients will be randomly assigned to either the drug or cardiovascular therapy group. Before the study, the sample size calculation should be done, and inclusion and exclusion criteria should be established to ensure that the study population is representative and meets the requirements (Borgharkar & Das, 2019). The study should strictly adhere to ethical principles, including informed consent, confidentiality, and participant safety. Data on blood sugar control should be collected through laboratory testing or continuous glucose monitoring, and other relevant clinical data should also be ordered to assess the participants’ overall health (Prattichizzo et al., 2019). Appropriate statistical methods should be used to analyze the results, and the study findings should be reported clearly and concisely. The evaluation plan should also consider the study’s potential limitations, including biases and confounding factors that could impact the study outcomes. Finally, the program should include a dissemination strategy to communicate the findings to relevant stakeholders, such as healthcare providers, researchers, and patients, to improve patient care and guide future research (Gifford et al., 2018).

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Problem Statement

Managing Type 2 Diabetes remains a significant challenge due to the numerous treatment options available. Patients with Type 2 Diabetes need effective interventions that can help them achieve optimal glycemic control while reducing the risk of cardiovascular events. There is a need to promote healthy lifestyle behaviors that can help prevent Type 2 Diabetes, such as regular exercise, healthy eating habits, and maintaining a healthy weight (Prattichizzo et al., 2019).

Healthcare providers must ensure that patients with Type 2 Diabetes receive appropriate care to achieve optimal glycemic control and reduce the risk of complications. This can be achieved through regular monitoring of blood glucose levels, medication adherence, and patient education. Prevention efforts should focus on identifying patients at risk of developing Type 2 Diabetes and implementing interventions to prevent its onset. This can include lifestyle modifications and targeted screening programs. Patient education is essential in managing Type 2 Diabetes (Borgharkar & Das, 2019). Patients must understand the importance of medication adherence, blood glucose monitoring, healthy lifestyle behaviors, and the potential complications associated with the disease. Effective management of Type 2 Diabetes requires a multidisciplinary approach that includes healthcare providers, patients, and their families. Management strategies should focus on achieving optimal glycemic control, reducing the risk of complications, and improving patients’ quality of life (Prattichizzo et al., 2019).

Population and Setting

  • Target population: Patients diagnosed with Type 2 Diabetes.
  • Setting: A hospital or medical clinic that provides comprehensive care for patients with diabetes.
  • Identified need: The need to determine the most effective treatment for controlling blood sugar in patients with Type 2 Diabetes.
  • Intervention: Drug therapy (I) compared to cardiovascular treatment (C).
  • Outcome: Blood sugar control (O) over 1 month (T).

The study would involve recruiting patients with Type 2 Diabetes willing to participate in a clinical trial comparing the effectiveness of drug therapy versus cardiovascular therapy on blood sugar control. The patients would be randomly assigned to the drug or cardiovascular therapy groups. The drug therapy group would receive medications designed to control blood sugar levels. In contrast, the cardiovascular therapy group would receive treatment to improve cardiovascular health, such as regular exercise and a healthy diet (Reaven et al., 2019).

Throughout the study, blood sugar levels would be monitored in both groups to determine which intervention is more effective at controlling blood sugar levels. The study would occur in a hospital or medical clinic setting, where patients would receive comprehensive care from a team of healthcare professionals, including physicians, nurses, and dietitians. The study results would provide valuable information to healthcare professionals, helping them determine the most effective treatment for patients with Type 2 Diabetes to control blood sugar levels and improve overall health (Gifford et al., 2018).

Intervention Overview

Drug therapy involves the use of medications that help regulate blood sugar levels. These drugs can include metformin, sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and insulin. Each medication works slightly differently to help manage blood sugar levels. For example, metformin decreases the amount of glucose the liver produces, while GLP-1 receptor agonists increase insulin production and slow down glucose absorption in the gut (Rodriguez-Gutierrez et al., 2019).

Cardiovascular therapy focuses on managing the risk factors contributing to cardiovascular disease, a common complication of type 2 diabetes. This can include lifestyle modifications such as exercise, dietary changes, smoking cessation, and medications to control blood pressure and cholesterol levels (Borgharkar & Das, 2019).

A randomized controlled trial could be carried out to evaluate the effects of medication treatment and cardiovascular therapy on blood sugar control over the course of a month in patients with type 2 diabetes. Patients would be randomly assigned to receive either drug or cardiovascular therapy, and blood sugar levels would be measured at the beginning and end of the month-long intervention period (Gifford et al., 2018).

The study could also collect data on secondary outcomes such as changes in weight, blood pressure, and cholesterol levels. This would provide a more comprehensive understanding of the impact of each intervention on overall health outcomes. Both drug and cardiovascular therapy can be effective interventions for managing type 2 diabetes and improving blood sugar control. The choice of intervention will depend on the individual patient’s needs and preferences and any comorbidities they may have. A healthcare provider can work with the patient to determine the most appropriate intervention based on their individualized care plan (Zhu et al., 2020).

Potential Interprofessional Alternatives

The study question of contrasting drug treatment versus cardiovascular therapy for blood sugar control in patients with Type 2 Diabetes over a month could be addressed by taking into account several interprofessional alternatives as well as telehealth. Here are four possible options:

  • Collaboration between Primary Care Physicians and Pharmacists (Borgharkar & Das, 2019)
  • Diabetes Educator and Nutritionist Team (Kirtley & O’Mahony, 2020).
  • Telehealth Visits with Endocrinologists (Gifford et al., 2018).
  • Group Medical Visits (Kirtley & O’Mahony, 2020).

    Outcome

This intervention’s aim is to assess the effects of cardiovascular treatment and drug therapy on Type 2 Diabetes patients over the period of a month. The purpose is to determine which therapy is more effective in managing blood sugar levels in this patient population. The intended accomplishment is to provide evidence-based information that can guide clinical decision-making in selecting the appropriate therapy for individual patients. Ultimately, the goal is to improve the management of Type 2 Diabetes and prevent complications associated with uncontrolled blood sugar levels (Zhu et al., 2020).

Time Frame

It is difficult to create and put into practice an intervention that will evaluate the impact of drug treatment and cardiovascular therapy on blood sugar control in patients with Type 2 Diabetes within a month of the need being recognized (Gifford et al., 2018). However, the following is a rough time frame that could be considered:

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Week 1

Gather a team of healthcare professionals with expertise in diabetes management, including endocrinologists, pharmacists, and nurses, and establish a clear action plan.

Review the literature and identify the most effective drug and cardiovascular therapy options for Type 2 Diabetes management. Develop a protocol for the study, including inclusion and exclusion criteria, informed consent process, data collection methods, and analysis plan (Dahl et al., 2022).

Week 2

Obtain institutional review board (IRB) approval for the study. Train healthcare professionals in the survey of the protocol and data collection methods. Begin recruiting eligible patients with Type 2 Diabetes who meet the inclusion criteria and obtain informed consent (Dahl et al., 2022).

Week 3

Randomly assign eligible patients to receive either drug therapy or cardiovascular therapy. Monitor patients’ blood sugar levels daily and record data on their response to treatment. Collect and analyze data to assess drug and cardiovascular therapy’s effect on blood sugar control (Borgharkar & Das, 2019).

Week 4

Complete data analysis and write up the results. Develop a plan for disseminating the findings to healthcare professionals and patients. Consider the study’s limitations and plan for future research (Dahl et al., 2022).

Knowledge Gaps

While this research question is pretty specific, some knowledge gaps, unknowns, or missing information still need to be addressed before conducting a study. Some of these include:

  1. Numerous drugs and medicines are available for managing Type 2 Diabetes and cardiovascular health, so it’s essential to specify which ones will be included in the study.
  2. Different methods of measuring blood sugar control include fasting blood glucose levels, HbA1c levels, and continuous glucose monitoring. The specific method used can affect the results of the study.
  3. The effectiveness of drug therapy versus cardiovascular therapy may vary depending on the patient population, so it is essential to specify the demographic and clinical characteristics of the study population.
  4. The study design can affect the validity and generalizability of the results (Zhu et al., 2020).

Addressing these knowledge gaps and unknowns is essential for designing a well-conducted and rigorous study that can provide valuable insights into the effectiveness of drug therapy versus cardiovascular therapy for blood sugar control in patients with Type 2 Diabetes.

Literature Review

Several studies have investigated drug and cardiovascular therapy’s effect on blood sugar control in inpatients with type 2 diabetes. A randomized controlled trial compared the effect of metformin (a drug therapy) and exercise (a cardiovascular medicine) on glycemic control in hospitalized patients with type 2 diabetes (Dahl et al., 2022). The study found that both interventions significantly reduced fasting blood glucose levels, but the exercise group had a more significant reduction. Another randomized controlled trial compared the effect of insulin (a drug therapy) and aggressive cardiovascular risk reduction (a cardiovascular medicine) on glycemic control in inpatients with type 2 diabetes (Pradeepa et al., 2019). 

The study found that insulin therapy was more effective in reducing blood glucose levels and achieving glycemic targets than cardiovascular risk reduction. Several studies have investigated drug and cardiovascular therapy’s effectiveness in T2D patients. A randomized controlled trial (RCT) compared the effect of the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin versus placebo on cardiovascular outcomes in T2D patients with or without established CVD (Mercieca-Bebber et al., 2018). The study found that dapagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure by 26% compared to placebo (Mathews et al., 2019).

Multiple randomized controlled trials (RCTs) have investigated the effectiveness of drug therapy versus cardiovascular therapy in preventing blood sugar levels in patients with T2D. For instance, a systematic review and meta-analysis of 11 RCTs, which compared the effects of drug therapy versus cardiovascular therapy on glycemic control in T2D patients, found that drug therapy was more effective in lowering HbA1c levels than cardiovascular therapy (Kirtley & O’Mahony, 2020).

Another RCT published in the New England Journal of Medicine compared drug and cardiovascular therapy effects on HbA1c levels in patients with T2D over six months. The study found that patients in the drug therapy group had a significantly more significant reduction in HbA1c levels than those in the cardiovascular therapy group (Mathews et al., 2019). Another RCT compared the effect of the SGLT2 inhibitor canagliflozin versus placebo on cardiovascular outcomes in T2D patients with or without established CVD. The study found that canagliflozin reduced the risk of cardiovascular death or hospitalization for heart failure by 14% compared to a placebo (Kirtley & O’Mahony, 2020). On the other hand, a study compared the effect of intensive glycemic control versus standard care on cardiovascular outcomes in T2D patients. The study found that intensive glycemic control did not significantly reduce the risk of cardiovascular events compared to usual care (Rasoul et al., 2019).

A retrospective cohort study compared the effect of antidiabetic drugs (a drug therapy) and lipid-lowering medications (a cardiovascular therapy) on glycemic control in hospitalized patients with type 2 diabetes. The study found that both drug therapies effectively reduced blood glucose levels, but antidiabetic drugs were more effective in achieving glycemic targets (LeRoith et al., 2019). A systematic review and meta-analysis compared the effect of drug therapy and lifestyle interventions (a combination of cardiovascular and behavioral therapies) on glycemic control in inpatients with type 2 diabetes. The study found that drug therapy was more effective in reducing blood glucose levels and achieving glycemic targets than lifestyle interventions (Tsiamparlis-Wildeboer et al., 2023).

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Health Policy

Health policies that could impact the approach taken to address the identified need for Type 2 Diabetes in patients in the United States include:

Affordable Care Act (ACA)

The ACA, a federal law enacted in 2010, has provisions that could positively impact individuals with Type 2 Diabetes. For example, the law prohibits insurance companies from denying coverage to individuals with pre-existing conditions, such as Type 2 Diabetes. It also includes provisions that require insurance companies to cover certain preventive services, including diabetes screenings, at no cost to the patient (LeRoith et al., 2019).

Medicare

Medicare is a federal health insurance program primarily serving people over 65 years old or with specific disabilities. Medicare covers many essential services for managing Type 2 Diabetes, including doctor visits, hospitalizations, and medications. In addition, Medicare covers diabetes self-management education programs and medical nutrition therapy, which can help patients learn how to manage their condition and make healthy lifestyle choices (Dahl et al., 2022).

Food and Drug Administration (FDA)

The FDA is a federal agency that regulates the safety and effectiveness of drugs, medical devices, and other products. The FDA has approved several medications for treating Type 2 Diabetes, including metformin, sulfonylureas, and insulin. The agency also regulates continuous glucose monitoring systems, which can help patients with Type 2 Diabetes monitor their blood sugar levels in real time (Rasoul et al., 2019).

National Diabetes Prevention Program (NDPP)

The NDPP is a public health initiative that aims to prevent or delay the onset of Type 2 Diabetes in individuals with prediabetes. The program provides education and support to help individuals make lifestyle changes, such as losing weight and increasing physical activity, that can reduce their risk of developing Type 2 Diabetes. The NDPP is supported by the Centers for Disease Control and Prevention (CDC) and is available in many communities across the United States (Mercieca-Bebber et al., 2018).

There are a number of resources that can shed light on the impact of drug treatment versus cardiovascular therapy on controlling blood sugar in Type 2 Diabetes patients.One study published in the Journal of the American Medical Association (JAMA) compared the effectiveness of two different drug therapies for Type 2 Diabetes, metformin, and sulfonylureas, and found that both medications were similarly effective at reducing blood sugar levels over one year. Another study published in the New England Journal of Medicine (NEJM) compared the effectiveness of two different cardiovascular therapies, fenofibrate, and simvastatin, in patients with Type 2 Diabetes and found that neither medication was effective at reducing cardiovascular events over five years (Pradeepa et al., 2019).

Intervention Plan

An intervention plan for the PICOT question “In patients with Type 2 Diabetes (P), what is the effect of drug therapy (I) compared to cardiovascular therapy (C) on blood sugar control (O) over 1 month (T)?” would include the following major components:

Identify Eligible Patients: The first step is to identify patients who meet the inclusion criteria for the study. Patients with Type 2 Diabetes would be eligible for the study (Dahl et al., 2022).

Recruitment and Consent Process: The study will require obtaining informed consent from eligible patients before providing any intervention. The consent process should be conducted in a culturally appropriate manner, ensuring that the patient understands the risks and benefits of participating in the study (LeRoith et al., 2019).

Randomization: Eligible patients would be randomly assigned to either the drug therapy or cardiovascular therapy group to ensure that each group is comparable in age, sex, and other relevant demographic variables.

Intervention: The intervention for each group would be provided according to the assigned therapy. In this case, one group would receive drug therapy, and the other would receive cardiovascular treatment (LeRoith et al., 2019).

Monitoring and Follow-up: Patients in each group would be monitored regularly to assess their blood sugar control over the 1-month study period. This would involve regular blood glucose testing and tracking any adverse effects of the interventions (Rasoul et al., 2019).

Data Analysis: After the study period, data would be analyzed to determine the effect of drug therapy compared to cardiovascular treatment on blood sugar control. The analysis would involve statistical tests to determine if there were any significant differences between the two groups (Rasoul et al., 2019).

Dissemination of Results: The study’s findings will be disseminated to healthcare providers and relevant stakeholders to inform clinical practice and policy decisions (Mercieca-Bebber et al., 2018).

Overall, the intervention plan should ensure that patients receive appropriate therapy, that data is collected accurately and reliably, and that the results are disseminated effectively to inform clinical practice and policy decisions.

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Impact of Cultural Needs

A successful intervention strategy must take into account the cultural needs, target population characteristics, and the environment when developing its components. Cultural differences can significantly impact the effectiveness of healthcare interventions. Thus, it is important to consider the target population’s cultural requirements, as well as the environment’s characteristics, into account when creating an intervention plan (Yip, 2021).

In the case of patients with Type 2 Diabetes, cultural factors such as diet, lifestyle, beliefs, and values may play a crucial role in the success of an intervention plan. For instance, some cultures may value traditional medicine over modern medicine, affecting the patient’s willingness to take drug therapy. In such cases, it may be necessary to incorporate cultural beliefs and values into the intervention plan by educating the patient on the benefits of drug therapy while respecting their traditional practices (Mercieca-Bebber et al., 2018).

Furthermore, the target population’s economic status, level of education, and language may also impact the development of intervention plan components. For instance, patients with a low level of education may require more simplistic language and visual aids to understand the importance of drug or cardiovascular therapy on blood sugar control. Similarly, patients with lower economic status may face financial barriers in accessing healthcare services or affording medication, which can influence the choice of intervention plan components (LeRoith et al., 2019).

Theoretical Foundation

To evaluate theoretical nursing models, strategies from other disciplines, and healthcare technologies relevant to an intervention plan for the given PICOT question, we can consider the following three nursing models:

Self-Care Deficit Theory by Dorothea Orem

This theory emphasizes the importance of self-care in maintaining an individual’s health. According to this theory, patients with Type 2 Diabetes can benefit from self-care practices that promote blood sugar control, such as monitoring blood glucose levels, adhering to a healthy diet, and engaging in regular physical activity (Yip, 2021).

Intervention Strategy: The intervention plan can focus on educating patients on self-care practices that promote blood sugar control. This can include providing information on monitoring blood glucose levels, diet modification, and physical activity. Patients can also be taught techniques to manage stress, which can impact blood sugar levels (Yip, 2021).

Health Promotion Model by Nola Pender

This model focuses on promoting health and preventing disease through behavior change. It emphasizes the importance of individual perceptions of health and the role of social support in promoting healthy behaviors.

Intervention Strategy: The intervention plan can involve assessing patients’ health perceptions and readiness to change their behavior. This can be done through interviews or questionnaires. Patients can receive personalized education and support based on the assessment to promote healthy behaviors and control blood sugar (LeRoith et al., 2019).

Chronic Care Model

This model emphasizes the importance of a multidisciplinary approach to managing chronic diseases. It involves coordinating care between healthcare professionals and patients and using evidence-based practices to manage the disease.

Intervention Strategy: The intervention plan can involve a team-based approach to managing Type 2 Diabetes. This can include applying a nurse, dietitian, and physician in the patient’s care. The team can work together to develop a personalized care plan for the patient, which may involve drug therapy, cardiovascular therapy, self-care practices, and lifestyle modifications (Mercieca-Bebber et al., 2018).

An intervention plan can also involve collaboration with pharmacists and social workers regarding strategies from other disciplines. Pharmacists can provide medication management support and education, while social workers can help navigate insurance and access community resources. Healthcare technologies relevant to the intervention plan include wearable devices for monitoring blood glucose levels, mobile apps for tracking physical activity and nutrition, and telehealth services for remote monitoring and support (LeRoith et al., 2019).

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Major Components of Intervention

When associating the effects of drug treatment and cardiovascular medicine on the regulation of blood sugar over a one-month period in Type 2 Diabetes patients, the following factors can be taken into account:

Drug Therapy

Medications for treating Type 2 Diabetes include Metformin, Sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT2 inhibitors, and insulin. Evidence from a systematic review and meta-analysis of 42 randomized controlled trials (RCTs) showed that treatment with DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors significantly reduced HbA1c levels compared to placebo, with fewer adverse events and lower risk of hypoglycemia than with insulin therapy (LeRoith et al., 2019).

Cardiovascular Therapy

Cardiovascular therapy in Type 2 Diabetes aims to reduce the risk of cardiovascular disease (CVD) events. Treatment options include statins, ACE inhibitors, ARBs, and antiplatelet therapy. Evidence from a systematic review and meta-analysis of RCTs showed that statin therapy significantly reduces the risk of major cardiovascular events in patients with Type 2 Diabetes (Navarese et al., 2013). ACE inhibitors and ARBs have also been shown to reduce the risk of CVD events in patients with Type 2 Diabetes.

Blood Sugar Control

Blood sugar control in patients with Type 2 Diabetes is typically assessed by measuring HbA1c levels. Evidence from a systematic review and meta-analysis of RCTs showed that DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors significantly reduced HbA1c levels compared to placebo (Wu et al., 2021). Statin therapy has also reduced HbA1c levels in patients with Type 2 Diabetes (Yip, 2021).

Duration of Intervention

When contrasting drug treatment with cardiovascular therapy for blood sugar control over a month, the duration of the intervention is a crucial factor to take into account. Evidence from a systematic review and meta-analysis of RCTs showed that treatment with DPP-4 inhibitors, GLP-1 receptor agonists, and SGLT2 inhibitors significantly reduced HbA1c levels compared to placebo over a longer duration (up to 52 weeks). Statin therapy has also considerably reduced the risk of major cardiovascular events in patients with Type 2 Diabetes over a more extended period (up to 5 years) (LeRoith et al., 2019).

Overall, based on the available evidence, an intervention for patients with Type 2 Diabetes comparing drug therapy with cardiovascular therapy on blood sugar control over 1 month could include treatment with DPP-4 inhibitors, GLP-1 receptor agonists, or SGLT2 inhibitors for blood sugar control, and statins, ACE inhibitors, or ARBs for cardiovascular risk reduction. However, it is essential to note that the choice of intervention should be individualized based on the patient’s clinical profile and preferences (Dahl et al., 2022).

Stakeholder Needs, Health Care Policy, Regulations, and Governing Bodies

Patients, healthcare professionals, insurance companies, pharmaceutical firms, and governmental organizations are among the participants in the healthcare industry. Regarding the PICOT question, the stakeholders’ needs vary depending on their role in diabetes management. They may also have preferences regarding the type of intervention they receive. Healthcare providers need access to evidence-based interventions to manage diabetes effectively. They also need support from governing bodies to implement and monitor interventions (Mathews et al., 2019). Insurance providers may have concerns about the cost-effectiveness of interventions and may need evidence to support coverage decisions. Pharmaceutical companies may be interested in developing new drugs or repurposing existing drugs for diabetes management. Government agencies have a role in setting policies and regulations to ensure the safety and effectiveness of interventions. They may also provide funding and support for research and implementation of interventions (Freeman, 2019).

Healthcare Policy

Healthcare policy plays a significant role in the management of diabetes. Policy decisions can influence access to care, intervention funding, and healthcare provider reimbursement. Policies can also impact the availability and affordability of drugs and other interventions. In the case of the PICOT question, healthcare policy may affect the availability and affordability of medicines and cardiovascular therapy. Policy decisions can also influence the use of these interventions in clinical practice.

Regulations

Regulations aim to ensure the safety and effectiveness of interventions. Regarding the PICOT question, laws may impact the approval and use of drugs and cardiovascular therapies. Restrictions may also affect the training and qualifications of healthcare providers administering these interventions (LeRoith et al., 2019).

Governing Bodies

Governing bodies like the FDA and professional associations regulate and oversee healthcare interventions. They guide the safety and effectiveness of interventions and may also support research and implementation. In the case of the PICOT question, governing bodies may have a role in regulating the approval and use of drugs and cardiovascular therapies. They may also guide the use of these interventions in clinical practice (Freeman, 2019).

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Specific Components of an Intervention Plan

An intervention plan for diabetes management typically includes several components, such as lifestyle modifications, pharmacotherapy, and regular monitoring. In the case of the PICOT question, the specific details of the intervention plan will depend on the intervention being compared (drug therapy vs. cardiovascular therapy) (Tsiamparlis-Wildeboer et al., 2023).

Depending on the precise elements of the intervention plan, different stakeholders’ requirements, healthcare policies, laws, and governmental institutions will have different effects. For example, stakeholders’ needs may impact the choice of intervention and the mode of delivery, while healthcare policy and regulations may affect the availability and cost of interventions. Governing bodies may guide the safety and effectiveness of specific interventions and their appropriate use in clinical practice (Freeman, 2019).

Ethical and Legal Issues

Several ethical and legal issues need to be considered in this PICOT question.

  • Informed Consent (Tsiamparlis-Wildeboer et al., 2023).
  • Patient Autonomy (Freeman, 2019).
  • Non-maleficence (Mathews et al., 2019).
  • Beneficence (Arnold et al., 2020).
  • Confidentiality (Tsiamparlis-Wildeboer et al., 2023).

Legal Perspective

Healthcare providers can be held legally liable if they fail to obtain informed consent or provide treatment that does not align with the standard of care. Healthcare providers must comply with state and federal laws regarding the use of drugs and cardiovascular therapies. Medical malpractice can occur if a healthcare provider fails to provide appropriate care or treatment, harming the patient (LeRoith et al., 2019).

Organizational Change 

Any organizational change should be implemented to respect the rights and dignity of the affected individuals. The intervention plan should be based on the best available evidence to ensure it is safe and effective. The organization must have processes to monitor and evaluate the intervention plan’s effectiveness and ensure that it meets quality standards. The allocation of resources for the intervention plan should be fair and equitable and prioritize the patient’s well-being (Arnold et al., 2020).

Assumptions

Patients with Type 2 Diabetes have access to drug and cardiovascular therapy. Patients can adhere to the prescribed intervention for one month. Blood sugar control is an accurate and reliable measure of the effectiveness of the interventions. The interventions are prescribed and monitored by qualified healthcare professionals. The comparison between drug and cardiovascular therapy is based on the available evidence and guidelines for treating Type 2 Diabetes. The intervention has no significant adverse effects on the patient’s health or quality of life. The intervention results can be generalized to a larger population of patients with Type 2 Diabetes (LeRoith et al., 2019).

Implementation Plan

The following strategies for leading, managing, and putting into practice professional nursing practices will help to guarantee inter-professional cooperation when implementing an intervention plan for patients with type 2 diabetes:

  • The first step is to create a team of professionals from different disciplines, including nursing, pharmacy, endocrinology, nutrition, and cardiology. Each member should have a defined role and responsibility and collaborate and communicate with each other throughout the intervention plan (Freeman, 2019).
  • The team should establish clear communication channels that ensure that everyone is kept up-to-date with the progress of the intervention plan. This can include regular meetings, emails, or shared documents (Tsiamparlis-Wildeboer et al., 2023).
  • The team should develop a shared understanding of the goals of the intervention plan, and what success looks like. This ensures that everyone works toward the same outcomes and can collaborate effectively (Mathews et al., 2019).
  • A standardized care plan can help ensure consistency in care across the team. This can include protocols for medication management, blood sugar monitoring, and follow-up care (Arnold et al., 2020).
  • Education and training should be provided to all team members to ensure they have the necessary knowledge and skills to provide adequate care. This can include training on new medications, diabetes management, and communication skills (Freeman, 2019).
  • Regular feedback and assessment should be encouraged to identify improvement areas and celebrate successes. This can include patient feedback, team debriefs, and outcome evaluations (LeRoith et al., 2019).

Implications

The proposed strategy of using drug therapy versus cardiovascular therapy to improve blood sugar control in patients with type 2 diabetes has several implications for changes in healthcare delivery and costs. Here are some of the potential impacts:

Change in Treatment Approach: This strategy proposes a shift in the treatment approach for patients with type 2 diabetes. Typically, drug therapy is the primary treatment for diabetes, but this strategy suggests that cardiovascular therapy could be an alternative approach. This policy change would require healthcare providers to be trained in the new therapy, which could result in additional costs (Tsiamparlis-Wildeboer et al., 2023).

  • Impact on Patient Outcomes: The proposed strategy aims to improve blood sugar control, which can lead to improved health outcomes for patients with type 2 diabetes. Better blood sugar control can reduce the risk of complications such as heart disease, nerve damage, and kidney damage. However, the effectiveness of the proposed strategy on patient outcomes would need to be studied and evaluated (Freeman, 2019).
  • Cost Savings: The strategy suggests using cardiovascular therapy as an alternative to drug therapy, potentially resulting in cost savings for patients and healthcare systems. Cardiovascular therapy may be less expensive than drug therapy, which could reduce the overall cost of treatment. However, the cost-effectiveness of this strategy would depend on the specific therapy chosen and the patient population (Arnold et al., 2020).
  • Implementation Challenges: Implementing a new therapy approach can be challenging, and healthcare providers may face resistance from patients accustomed to drug therapy. Additionally, there may be challenges in finding qualified healthcare providers trained in cardiovascular treatment (LeRoith et al., 2019).

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Delivery and Technology

Assuming that the intervention to improve the quality of the project is related to the implementation of drug therapy or cardiovascular therapy, the appropriate delivery methods are:

In-person Appointments with Healthcare Providers: Patients can schedule appointments to receive personalized treatment recommendations and ongoing monitoring of their blood sugar levels (Freeman, 2019).

Telemedicine: Remote consultations using telemedicine technology can be used to deliver drug therapy or cardiovascular therapy. This method allows patients to access treatment from the comfort of their homes while still receiving personalized care (LeRoith et al., 2019).

Patient Education: Providing patients with educational resources, such as brochures, videos, or online courses, can help them understand the benefits and risks of drug and cardiovascular therapy. This knowledge can help patients make informed decisions about their treatment plans and improve adherence (Arnold et al., 2020).

Group Sessions: They can allow patients to learn from each other and share their experiences with drug or cardiovascular therapy. This method can be beneficial for addressing common concerns or questions that patients may have (Adu et al., 2019).

Mobile applications: Mobile applications can deliver reminders, tracking tools, and educational resources to patients. This method can be beneficial for improving adherence to drug therapy or cardiovascular therapy, which is critical for achieving blood sugar control (LeRoith et al., 2019).

Stakeholders, Policy, and Regulations

The stakeholders in implementing an intervention plan for Type 2 Diabetes include patients, healthcare providers (e.g., doctors, nurses, pharmacists, and other allied health professionals), payers (e.g., insurance companies), policymakers, and researchers (LeRoith et al., 2019).

Regulatory Implications

Implementing an intervention plan for patients with Type 2 Diabetes involves regulatory implications that must be considered. The use of drugs for the management of diabetes requires compliance with regulations from regulatory agencies such as the FDA. Cardiovascular therapy in diabetic patients may also have regulatory implications as it involves using drugs approved for managing cardiovascular diseases. It is, therefore, necessary to ensure that the intervention plan is consistent with the regulations and guidelines set by the relevant regulatory agencies (Borgharkar & Das, 2019).

Potential Support

Implementing an intervention plan for patients with Type 2 Diabetes requires support from different stakeholders. Patients with diabetes need help from healthcare providers regarding education on managing their condition, medication management, and lifestyle changes. Healthcare providers require support from policymakers and researchers in terms of guidelines and evidence-based recommendations for managing diabetes. Payers need to provide support by covering the cost of the intervention plan. Finally, researchers need to provide support by researching to generate evidence to support the effectiveness and safety of the intervention plan (Tsiamparlis-Wildeboer et al., 2023).

Another policy consideration that could be implemented to support the intervention plan is increasing funding for diabetes research. This funding would support the development of new drugs and therapies that could be more effective in managing blood sugar levels. Furthermore, it could help implement programs that provide diabetes education and promote healthy lifestyle choices, such as regular exercise and a healthy diet. By implementing these policies, patients with type 2 diabetes could have better access to the resources and support needed to manage their blood sugar levels effectively (Ceriello et al., 2020).

Time Line

Developing an intervention plan for patients with Type 2 Diabetes requires careful consideration of several factors. These factors include the complexity of the patient’s condition, the type of medication or therapy involved, patient preferences, and potential side effects of the treatment. Based on these factors, here is a proposed timeline for implementing the intervention plan over one month:

Week 1

  • Initial assessment 
  • Educate the patient 
  • Prescribe either drug therapy or cardiovascular therapy
  • Monitor blood sugar levels

Week 2

  • Review the patient’s progress 
  • Reinforce the importance of medication adherence and lifestyle modifications.
  • Monitor the patient’s blood sugar levels 

Week 3

  • Review the patient’s progress 
  • Educate the patient on potential side effects 
  • Monitor the patient’s blood sugar levels 

Week 4

  • Final review of the patient’s progress 
  • Educate the patient on the long-term management of Type 2 Diabetes 
  • Schedule a follow-up appointment treatment plan if necessary.

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Assumptions

Patients have been appropriately diagnosed with Type 2 Diabetes through appropriate screening and diagnostic testing. Patients are willing and able to participate in the study, follow the intervention plan, and attend all necessary appointments. The drug and cardiovascular therapy used in the study are appropriate and safe for the patients included. Patients’ medical histories have been thoroughly reviewed to ensure that they do not have any contraindications to the drug or cardiovascular therapy being used. Patients have been educated on the potential side effects of medication and cardiovascular therapy and the importance of adhering to their treatment plan (Ceriello et al., 2020). 

Evaluation of the Plan

The outcomes that are the goal of an intervention plan will depend on the specific condition being treated and the purposes of the healthcare provider and patient. In the case of an intervention plan for patients with Type 2 Diabetes, the following outcomes may be considered:

  1. Improved blood sugar control
  2. Reduced risk of complications
  3. Improved quality of life
  4. Improved self-management skills (Dahl et al., 2022)

Objective: The evaluation plan calls for monitoring Type 2 Diabetes patients for a month in order to evaluate the effects of medication regimen and circulatory care on blood sugar control.

Study Design: The study will be a randomized controlled trial with two arms: the drug and cardiovascular therapy arms.

Study Population: The study population will consist of patients diagnosed with Type 2 Diabetes receiving medical care in a hospital or clinic.

Sample Size: The sample size will be calculated based on the estimated effect size of the intervention and the power required for the study. Having a minimum of 30 participants in each arm of the study is recommended (LeRoith et al., 2019).

Inclusion Criteria: Patients will be included in the study if they meet the following criteria:

  • Age 18 years or older
  • Diagnosis of Type 2 Diabetes
  • currently receiving medical care in a hospital or clinic
  • Able to give informed consent (LeRoith et al., 2019)

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Exclusion Criteria: Patients will be excluded from the study if they meet any of the following criteria:

  • Pregnancy or lactation
  • Type 1 Diabetes
  • Severe hypoglycemia or hyperglycemia
  • Allergy or intolerance to the medications used in the study (Mathews et al., 2019)

Intervention: Participants in the drug therapy arm will receive medication for blood sugar control, while those in the cardiovascular therapy arm will receive medication for cardiovascular risk reduction.

Outcome Measures: The primary outcome measure will be blood sugar control, measured by glycated hemoglobin (HbA1c) levels at the end of the 1-month study period. Secondary outcome measures will include changes in blood pressure, lipid levels, and adverse events.

Data Collection: At the beginning and the conclusion of the one-month study period, data will be gathered. Data will be collected using electronic medical records and patient self-report (Adu et al., 2019).

Data Analysis: Data will be analyzed using statistical methods to compare the mean changes in HbA1c levels between the two study arms. Additional analyses will be conducted to compare changes in secondary outcome measures and identify any adverse event differences between the two study arms (Dahl et al., 2022).

Ethics Approval: An ethics committee will review and approve the study before it begins. Before any participant is admitted to the research, they will all provide their informed consent.

Dissemination: The study results will be disseminated through publication in peer-reviewed journals and presentation at relevant conferences. The results will also be shared with the healthcare community to inform clinical practice and decision-making (Adu et al., 2019).

Assumption

When contrasting the effects of cardiovascular therapy versus drug therapy on the regulation of blood sugar in patients with Type 2 Diabetes over the duration of one month, the following hypotheses could be taken into consideration: The study participants have been diagnosed with Type 2 Diabetes and have not previously received either drug therapy or cardiovascular therapy. Participants have similar baseline blood sugar levels, as measured by HbA1c. The study is randomized and double-blinded, with patients assigned to either the drug therapy or cardiovascular therapy group in a random manner. Drug and cardiovascular medicine are administered according to standard guidelines and protocols for treating Type 2 Diabetes. Participants are monitored closely for adverse or side effects of medication or cardiovascular therapy (Khalili et al., 2019).

Discussion

Type 2 diabetes is a chronic condition that affects how the body processes blood sugar (glucose). Glucose is a vital energy source for the body’s cells, and insulin is a hormone that helps regulate glucose levels in the blood. In type 2 diabetes, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain normal glucose levels. Type 2 diabetes is the most common type of diabetes, accounting for about 90-95% of all cases (Mathews et al., 2019). It typically develops slowly over time and is often associated with obesity, a sedentary lifestyle, and poor dietary habits. Other risk factors for type 2 diabetes include age, family history, and certain medical conditions such as high blood pressure and cholesterol (Mathews et al., 2019). Over time, high blood glucose levels can cause damage to various organs and systems in the body, leading to complications such as cardiovascular disease, kidney damage, nerve damage, and vision problems. Type 2 diabetes is usually treated with lifestyle modifications like weight loss, consistent exercise, and healthy eating. In some cases, medications such as metformin, sulfonylureas, and insulin may also help control blood glucose levels. Regular monitoring of blood glucose, blood pressure, and cholesterol levels is also essential for the early detection and management of type 2 diabetes (Khalili et al., 2019).

Advocacy

A nurse’s leadership in driving change and enhancing the standard and experience of care is essential. Nurses play a key role in managing patients with Type 2 Diabetes, as they are often the primary healthcare providers in this area (Lee et al., 2019). Nurses can lead changes and drive improvements by:

  • Developing and implementing evidence-based practices to improve patient outcomes and experience. 
  • Participating in interdisciplinary teams to improve care coordination and communication among healthcare providers
  • Advocating for patients and their families to ensure their voices are heard in decision-making processes
  • Providing education and support to patients and families to improve their self-management skills and promote health literacy
  • Conducting research and quality improvement projects to identify and address gaps in care delivery (Lee et al., 2019)

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Intervention plans significantly impact nursing and interprofessional collaboration, requiring a team-based approach. The project will likely involve multiple healthcare professionals, including nurses, physicians, pharmacists, dietitians, and other specialists, who collaborate to develop and implement an effective treatment plan for the patient (Adu et al., 2019).

Interprofessional collaboration is essential in ensuring the intervention plan is comprehensive, coordinated, and patient-centered. The healthcare team will work together to identify the patient’s needs, set goals, and develop a treatment plan that addresses the patient’s individual needs and preferences. Effective communication among team members is critical to ensure that all aspects of the project are implemented consistently and that any concerns or changes in the patient’s condition are addressed promptly (LeRoith et al., 2019)—the healthcare field gains from the intervention plan in several ways. First, the program can improve patient outcomes, such as better blood glucose control, decreased complications, and improved quality of life. Second, the plan can help reduce healthcare costs associated with diabetes management by preventing hospitalizations, complications, and the need for costly interventions. Third, the program can help healthcare professionals deliver more efficient, coordinated, and effective care, leading to higher job satisfaction and better patient experiences (Lai et al., 2019).

Future Step

The following strategies could be taken into consideration in order to increase the project’s effect and benefit from new technology and care models:

  • Longer Follow-Up Period
  • Integration of Wearable Technology
  • Personalized Medicine
  • Patient-Centered Care
  • Collaborative Care Models (Rasoul et al., 2019)

Reflection on Leading Change and Improvement

As a Nurse, conducting the project on the effect of drug therapy versus cardiovascular therapy on blood sugar control in patients with Type 2 Diabetes has significantly impacted my ability to lead change in personal practice and future leadership positions. Through this project, I have learned the importance of evidence-based practice and the significance of research in shaping healthcare delivery. I have also developed my critical thinking skills and enhanced my ability to interpret research findings and apply them to patient care (Rasoul et al., 2019).

Furthermore, the project has deepened my understanding of managing Type 2 Diabetes and the various treatment options available. This knowledge will enable me to provide better patient education and counseling to promote adherence to therapy and improve treatment outcomes. In terms of leadership, this project has equipped me with the skills necessary to initiate and implement change in healthcare delivery (Martens et al., 2021). As a nurse, I understand the importance of quality improvement in patient care. In the context of patients with Type 2 Diabetes, effective interventions can significantly impact patient outcomes. To promote quality development in other contexts, the finished intervention, implementation, and evaluation plans can be applied to one’s own practice. I would begin by implementing the intervention plan for patients with Type 2 Diabetes. This may involve providing drug or cardiovascular therapy to patients over one month to improve blood sugar control. I would work closely with other healthcare professionals, such as physicians, pharmacists, and dieticians, to ensure the intervention plan is implemented effectively and safely. Next, I would focus on implementing the implementation plan to ensure that the intervention plan is being carried out correctly. This may involve monitoring patients closely, educating them on the importance of adhering to their medication or therapy regimen, and ensuring that healthcare providers follow the correct medication or therapy procedures (Rasoul et al., 2019).

Finally, I would use the evaluation plan to assess the effectiveness of the intervention plan. This may involve measuring blood sugar levels before and after the intervention, monitoring patient outcomes over time, and gathering patient feedback on their experience with the intervention. Based on the evaluation results, I would make any necessary adjustments to the intervention plan to improve its effectiveness. By implementing the intervention, implementation, and evaluation plans systematically and consistently, I believe that I can drive quality improvement in patient care for patients with Type 2 Diabetes. By focusing on evidence-based interventions and working closely with other healthcare professionals, I can ensure that patients receive the best possible care and achieve optimal outcomes (Mingrone et al., 2021).

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Conclusion

In conclusion, based on the evidence reviewed, drug and cardiovascular therapy positively affect blood sugar control in patients with Type 2 Diabetes. However, drug therapy may be more effective in reducing blood sugar levels in the short term than cardiovascular therapy. Additionally, lifestyle modifications such as diet and exercise should be incorporated as part of overall diabetes management. Further research is needed to compare the long-term efficacy and safety of drug therapy and cardiovascular therapy in managing Type 2 Diabetes and evaluate the potential benefits of combining these treatments. A personalized approach to diabetes management is crucial for achieving optimal blood sugar control and improving patient outcomes.

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