What is the Effect on Glycemic Control of Inhaled Insulin - Case Study Example

What is the Effect on Glycemic Control of Inhaled Insulin? Introduction This paper is a critique on an open, randomized, controlled study by Rosenstock, Zinman, Murphy, Clement, Moore, Bowering, Hendler, Lan, and Cefalu (2005) where the authors sought to establish the effect on glycemic control of inhaled insulin alone or added to dual oral therapy (insulin secretagogue and sensitizer) after failed dual oral therapy. This study covered 309 patients with type 2 diabetes with hemoglobin A1c level of 8% to 11% receiving dual oral therapy (Rosenstock, et.al., 2005). Outcome measures included changes in hemoglobin A1c levels from baseline after 12 weeks; hemoglobin A1c levels lower than 8% and less than 7%, hypoglycemia, lipid levels, pulmonary function, insulin antibody binding, and adverse events (Rosenstock, et.al., 2005). After interventions were carried out, the study revealed that inhaled insulin was able to improve overall glycemic control and hemoglobin A1c levels when it was added to or substituted for dual oral agent therapy with insulin secretagogue and sensitizer. Problem Statement The problem the study was conducted to resolve is an important one for nursing to explore because it presents alternate routes of treatment for diabetes. It presents a less traumatic and less invasive means of possibly administering insulin. In effect, the problem statement allows the nursing practice to consider the fact that the nurse may have to express to the patient other choices in his treatment for type 2 diabetes. The study purpose is significant to nursing in the sense that it has the potential of making the experience of medicine administration easier and less traumatic for the patient being cared for. For some patients who do not like using the insulin pens or needles, inhaled insulin would be a better route and option for them to consider. For nurses suggesting this option to patients, their job would be easier and their patients would likely be more cooperative during the administration of insulin. Moreover, higher medication compliance can be ensured for inhaled insulin intake. The main research question for this research is: What is the effect on glycemic control of inhaled insulin alone or added to dual oral therapy after failure of dual oral therapy? It also asked what the tolerability and safety of insulin therapy is over a 3-month period (Rosenstock, et.al., 2005). A possible hypothesis for this study is that glycemic control is better after the administration of inhaled insulin alone or added to dual oral therapy after dual oral therapy. The independent variable of this study is the insulin which can be changed to inhaled or combined with oral therapy. The dependent variable in this study is the glycemic control. The conceptual model or theoretical framework was used to guide this essay in the sense that it aligned the key elements of the research topic (Holliday, 2002). It implied that there is an eventual need for type 2 diabetic patients to require insulin if they do not achieve glycemic control with oral therapy. There is a need therefore to come up with ways in order to reduce such probability and to establish alternate routes to reduce blood sugar levels. Review of Related Literature The review of related literature was able to provide support for this study because it was able to cite studies on patients with type 1 and type 2 diabetes where inhaled insulin manifested with similar glycemic control in relation to conventional subcutaneous treatments (Rosenstock, et.al., 2005). It also showed how studies suggested that in failure of oral agent therapy to control blood glucose levels, inhaled insulin assisted in ensuring improved glycemic control (Rosenstock, et.al., 2005). These studies are however insufficient to prove the beneficial preference of inhaled insulin to oral therapy in decreasing blood glucose levels – hence the need for the study. Study Design The study design is “an open-label, parallel-group, multicenter, randomized study” (Rosenstock, et.al., 2005). Both the researcher and the respondents know what sort of treatment the patient is receiving (Chow & Shou, 2002). This study compares two different treatments administered to respondents. It also sets forth choices in treatment randomly. This design is appropriate for this study because it allowed for the application and comparison of two forms of treatment for this study (Polit & Beck, 2010). Its randomized methods also helped to ensure that the results of this study are applicable to a greater population. The sampling of the population appeared to be wide-spread. There were individuals throughout North America who took part in the study. Perhaps, the authors could have extended their efforts to include other cultures in addition to the ones studied to develop a wider understanding of response to therapy. Potential bias could have come from the physicians who referred potential participants to the study, as well as individuals who were selected had to demonstrate hemoglobin A1c levels in the range of 8-11% in order to participate. This bias could cause a positive skew of results since they were already close to the recommended blood levels ( Read More