Evidence based pratice - conducting a literature search and appraisal of research based on type 2 diabetes

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HE0811A Evidence Based Practice

BSc/BSc Honours in Nursing

Tayside Institute for Health Studies

Module HE0811A – Evidence Based Practice


Select one topic from the following:

1. The effectiveness of hand hygiene in infection control

2. Patient education in type 2 diabetes

3. The use of psychosocial plus pharmacological interventions for smoking cessation

4. Effectiveness of family interventions in the prevention of relapse in schizophrenia

5. Effectiveness of medication in the treatment of depression

6. Effectiveness of reminiscence therapy in the treatment of dementia


Undertake a literature search of the topic, searching a minimum of two databases e.g. CINHAL, MEDLINE, and Physcinfo etc. and present your findings.


Select one piece of original research from the findings of your literature search and appraise this paper.

Matriculation Number: -                                0605304

  • Introduction

There are currently 2.3 million people in the UK with diabetes, and up to 95% of them are type 2 diabetics (Diabetes UK, 2007a).  Life expectancy is reduced by up to 10 years in those with this type of disease (Whittaker, 2004); and much of the burden relating to care falls on the individuals themselves (Whittaker, 2004).  In the majority of cases, type 2 diabetes is treated with lifestyle changes such as healthier diet, weight loss, and increased physical exercise (Diabetes UK, 2007b); and maintaining blood glucose levels as close to normal as possible slows down the progression of long term complications (Whittaker, 2004).

Patient education has been recognised by many (Walsh, 2002. Brooker & Nicol, 2003 and Alexander et al, 2006) as fundamental in the treatment of type 2 diabetes; which is why the topic of patient education in people with this chronic condition has been chosen.  

  • Literature Search

Before performing a literature search, a clinical question must first be formulated and the best way to do this is by using the P.I.C.O. framework (Craig, 2007).  In this framework the “P” stands for population, the “I” for intervention, the “C” for comparison; and the “O” stands for outcome.

In this literature search the population used will be adults with type 2 diabetes.  The intervention is a patient education programme which will be compared with routine care; and the outcome intended is improved blood glucose; resulting in the following clinical question:

“Do patient education programmes for adults with type 2 diabetes improve blood glucose levels compared to routine care?”

However, although a clinical question has been formulated, consideration must be given to the different words which can be used to mean the same thing.  Therefore, when searching for information, different definitions were included and are detailed in the table on the following page.

Table 1 – Literature Search Details

  • The Research Article

Report Summary

From the literature search, one piece of research was available in both Medline and Embase.  It was compiled by Deakin et al (2006) and appeared to answer the previously formulated clinical question.  The piece was published by Diabetic Medicine, a peer reviewed journal featuring articles on diabetic research which gave the report credibility (Blackwell Publishing, 2007). Below is a summary of the report:


Title: Structured patient education: the Diabetes X-PERT Programme makes a difference.

Authors: T. A. Deakin, J. E. Cade, R. Williams and D. C. Greenwood

Date of study: Unknown         Date of publication: September 2006

Aim of study: To deliver a patient education programme that teaches self management skills resulting in long term improvements.

Hypothesis: Patient education programmes for adults with type 2 diabetes increase self-management and improve lifestyle over longer periods.

Sample and size: 314 adults living in Burnley, Pendle or Rossendale, Lancashire. 

Method of study and research tools to be used: A randomised control trial.  Participants were randomised into either the control or intervention group.  The control group were given individual appointments with a dietician, a practice nurse and a GP.  The Intervention group attended six weekly group sessions lasting 2 hours each; which was designed to develop skills and improve confidence on diabetes self care.

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Results: At 14 months, the X-PERT group showed significant improvement in HbA1C levels, body weight, BMI, waist circumference, physical activity levels, foot care, and fruit & vegetable intake.

Conclusions of the study: Participation in the X-PERT programme led to improvements in health and self management skills over longer periods.

Figure 1 – The Research Report Summary adapted from Lanoe, 2002

Why was it done?

Previous studies provided evidence that self-management programmes had a positive affect on glycaemic control.  However these effects did not seem to last and a meta analysis (Norris, 2002) on this issue ...

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