Effective Diabetes Management Practice - Research Proposal Example

Critique of a Quantitative Research Study: Improving Activity in Adults with Diabetes and Coexisting Obstructive Sleep Apnea Student’s Name Institutional Affiliation Introduction This research study involves participants with type two diabetes (T2DM).The authors’ state three objectives of the study in these participants. Firstly, there is need to determine the feasibility of carrying out a double blind and randomized placebo-controlled continuous positive airway pressure (CPAP) in the study participants treated with continuous positive airway pressure, compared with participants in the study on sham-CPAP. The other purpose is to examine physical activity in individuals treated with CPAP compared with those treated under sham –CPAP. Finally, the authors aim to explore pre to post-therapy changes in quality of sleep, daytime sleepiness, activity, fatigue and vigor. The authors clearly discuss the significance of the problem that triggers this research study based on the adverse effects on individual patient’s health and the economic setback of the problem. The investigators base the sense of their research study on the weight of adverse effects of type two diabetes, which a large body of evidence suggests that it is aggravated by obstructive sleep apnea. There is every logic to confirm the correlation between the two conditions and suggest a comprehensive and effective diabetes management practice. Problem Statement The problem statement is clear. Diabetes is a chronic illness that has adverse effects on the economy statuses of the state and the individual patient. For example, in the United States alone, approximately 25.8 million people were approximated to have diabetes in the year 2010.About 90% to 95 percent had type two diabetes(T2DM).The overall cost of diabetes in the year 2007 was $218 billion,$153 billion being in excess medical expenditures and $65 billion being the cost of reduction in national productivity. Poorly managed diabetes also leads to severe health problems such as kidney failure, amputation of lower limb, stroke and heart disease (P.295). The variables examined and the key research questions are clearly identified. For example during determination of inclusion or exclusion of participants, participants are asked about their sleeping duration, activity, age and medical history. Other variables on which questions are administered include mood, height and weight (P.299). Untreated obstructive sleep apnea contributes to poor glycemic control in diabetes type 2 patients. Consequently, clear understanding of the potential effects obstructive sleep apnea has on patients of diabetes through evidence-based research is a significant measure in fighting the diabetes menace in clinical practice (P.295) Literature Review The literature slightly but rationally reviews past related research findings. The literature is based on previous research findings (Aronsohn et.al) which put forward that sleep apnea is synergistic or additive to determinants of poor glycemic control in diabetes. The investigators describe this previous research as inadequate because it doesn’t clarify whether treatment of obstructive sleeping apnea is accompanied by improved behavioral results such as increased physical activity that is an important component of type 2 diabetes. Further, the investigators cite a recommendation by the American College of Sports & Medicine & the American Diabetes Association. The two bodies propose that regular physical activity helps in improving management of diabetes. However, the suggestion does not fully hold since most people with DT2 lead a sedentary lifestyle. It is on the gaps in these previous studies that the investigators stress the importance of the current research that aims at understanding the effects of OSA on glycemic control factors. Theoretical Framework and Hypothesis The investigators do not base their research on any conceptual framework. They also have not provided the theoretical basis for formulation of the hypothesis. However, the hypothesis is precisely stated, “Treatment of obstructive sleep apnea in adults coexisting with type 2 diabetes is associated with enhanced clinical outcomes.” This hypothesis is tested in this research study. Methodology Relevant variables and concepts used in the study are clearly and operationally defined. For example, obstructive sleep apnea is clearly defined as characterized by two components. These are apneas (stoppage of breathing for at least ten seconds) and hypopneas (reduction in breathing by at least thirty percent accompanied by a four percent or greater decrease in oxygen saturation). The methods of data collection are clearly stated. During the initial inclusion or exclusion determination phase, data from the recruited participants is obtained through a set script that is used for telephone screening. In other stages, technological devices (such as Bodymedia SenseWare Pro Armband) and questionnaires are used for data collection. (P.299).The investigators do not state any identified or potential threats to internal and external validity of the research. Sample The subjects to this study are persons with type 2 diabetes meeting the inclusion criteria primarily high apnea events and low AIC values. A computer program then randomizes these participants to either sham-CPAP or CPAP treatment groups, allocation being equal to each one of the two groups (P.301-302).The sample size is made up of 23 subjects, and it cannot be representative of the population given the many variables under investigation. The rights of the participants are protected since maintenance of confidentiality of the participants is considered in determining feasibility of the study (P.298). Instruments A variety of instruments for data collection are used. For example, stadiometer is used to measure height and apnea screening device is given to individuals for measuring apnea levels. The data from these measuring instruments can be relied on since the same instruments have been used in previous studies. Data Analysis Statistical tests used are identified and values reported. The baseline characteristics of subjects in CPAP group are compared with those in the sham CPAP group using two-sample t tests for continuous variables and Fisher’s exact tests for categorical variables. Appropriate statistics are used according to the various aspects of the research study. The analysis primarily uses descriptive statistical methods. Descriptive statistics are computed, and all continuous variables reported as mean +/- Standard Deviation. Categorical variables are reported as frequency and percent (P.301-302). Results The investigators clearly and objectively report the results of the hypothesis already stated. The authors declared no possible conflicts of interest in relation to the research, authorship and publication of the article. The results of the study propose that treatment of obstructive sleeping apnea in adults with type 2 diabetes might result in increased activity. The study also suggests that treatment of OSA objectively affects measured physical activity (P.308).This conclusion is based on various variables statistics presented in figure 1(consort diagram) and tables 2, 3 and 4. These results are described as being consistent with the results of a randomized clinical trial done by Tomfohr et al. who found that three weeks of active CPAP lead to substantially reduced fatigue and enhanced vigor. However, Tomfohr’s research excluded people with type 2 diabetes who are included in the current study (P.308). Conclusion The conclusions are based on the research findings and are related to the hypothesis. The research concludes that obstructive sleep apnea severity and extreme daytime sleepiness are associated with reduced physical activity. In addition, CPAP treatment of OSA reduces extreme daytime sleepiness and therefore has the potential to increase physical activity, a key health indicator. The research findings are limited. Due to the small sample size, there was no formal hypothesis testing, and individual cases might have influenced the findings. Further, the study did not attain the goal of all night, every night adherence to CPAP. The implications of the findings are discussed. The satisfactory findings of this pilot research should lead to a full-scale randomized and controlled clinical testing to the impact of CPAP on enhancing the required behavior for optimal control of diabetes. Standard education on diabetes should also be provided. Finally, the researchers recommend further studies on the hypothesis that OSA treatment in adults living with type 2 diabetes is linked to improved clinical results (P.308-309). Reference Chasens, E., Korytkowski, M., Sereika, S., Burke, L., Drumheller, O., & Strollo, P. (2014). Improving Activity in Adults with Diabetes and Coexisting Obstructive Sleep Apnea. Western Journal of Nursing Research, 36(3), 294-311. 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