Diabetes Mellitus: Evidence Synthesis

Topic: Healthcare Research
Words: 1767 Pages: 6


Diabetes mellitus and its complications are a severe global and national problem as the spread of this disease has increased significantly in the 21st century. For this reason, international and national health organizations make significant efforts to disseminate information about preventive measures and apply them to the population. This process requires a comprehensive study to assess the influence of physiological, psychological, and social factors and use them to form new strategies. This paper will feature articles on the importance of physical activity, the perception of individual and structural barriers, and the impact of diabetes on fracture risks among people with type 2 diabetes. The articles by Mathe et al., Pham and Nguyen, and Schillinger et al. present different aspects of the topic of preventing diabetes and its complications and contribute to the study of this national health problem.

Analysis of the Practice Problem

Diabetes mellitus is a global health problem of significant public concern. In high-income countries, the increase in the incidence of type 2 diabetes is increasing due to the availability and promotion of high-calorie and sugary products, less active lifestyles, and the popularity of fast food. At the same time, in countries and regions with high poverty rates, the prevalence of diabetes is growing due to the population’s limited access to nutritious food and health services. The situation is further complicated because although diabetes is a manageable disease, people who do not know their diagnosis or do not maintain a proper lifestyle suffer from multiple complications of diabetes. This behavior, in turn, can be caused by health neglect, insufficient understanding of the risks, or inaccessibility of means necessary for adherence to diet and prescriptions of doctors. For this reason, diabetes is a common cause of death and disability due to its effects on vascular function, which lead to diseases of the kidneys, eyes, limbs, and other organs. This feature is the main danger of diabetes, since it is not the diagnosis itself that is fatal but its effect on the body due to its improper management.

This trend is observed and cited in their works by many scientific authors, including researchers who will be discussed in this paper. For example, Mathe et al. (2017) note that people living with type 2 diabetes have a two to four times higher risk of cardiovascular disease than people without diabetes, taking into account smoking, hypertension, and dyslipidemia. These figures show only one of the complications caused by the malfunction of the vessels. Another consequence of diabetes is bone fragility, which significantly increases the risk of fractures and the duration of bone and tissue repair (Pham & Nguyen, 2019). This complication is dangerous by depriving a person of the person’s ability to move freely, which is necessary for normal muscle development and the prevention of other complications of diabetes. At the same time, recent trends show that the incidence of type 2 diabetes among young people has increased by 30%, although the disease is typically considered a problem in older people (Schillinger et al., 2019). The condition is manageable and preventable, but ignorance of people and insufficient government action increases morbidity and mortality. Thus, the issue of developing and implementing measures to prevent diabetes and its consequences is key to ensuring the health of millions globally and in the United States.

Evidence Synthesis

The analysis of scientific articles helped collect evidence of the need to prevent diabetes and its complications, and some of the findings will be useful for shaping prevention programs for the population. First, Pham and Nguyen (2019) conducted a systematic review to explain the high risk of fractures in people living with type 2 diabetes. The authors systematized data from 12 studies and concluded that people with diabetes have a lower trabecular bone score (TBS), although their bone mineral density is higher than people without diabetes. Therefore, this indicator is a valuable predictor of increased fracture risk in people living with diabetes and should be used in prevention programs.

Second, the need to strengthen prevention and health promotion programs is demonstrated by the fact that many people fail to take action to avoid the complications of diabetes. In a quantitative study, Mathe et al. (2017) measured the level of mobility of older people living with type 2 diabetes and compared them with the recommended amount of physical activity. The authors used an accelerometer and self-reporting accents to avoid participants’ bias in their responses. As a result, the authors found that only 10% of respondents fulfilled the recommendations for the time of moderate-vigorous physical activity per week, which is an alarming indicator (Mathe et al., 2019). In addition, it was also a helpful finding that women and employed people have lower levels of activity, which can be used to develop specific techniques that encourage exercise for these groups of populations.

Third, a concerning issue that underscores the need to prevent type 2 diabetes is that younger people are being diagnosed with the disease more often. Schillinger et al. (2018) note that the most significant increase in diabetes incidence is seen among minority youth and associate these factors with structural barriers. The authors use The Bigger Picture (TBP), which is a counter-marketing campaign, to educate children of color about diabetes prevention and find it effective because it empowers youth to be independent and challenge authorities. A significant proportion of respondents found that structural barriers such as low income, lack of healthy food stores, and advertising of unhealthy foods are factors that increase the incidence of diabetes among minorities (Schillinger et al., 2018). Part of these respondents is willing to take action and reduce the influence of these barriers. At the same time, many respondents did not deny the importance of individual choice toward a healthy lifestyle. Thus, the authors demonstrated the important social aspects that must be taken into account in the prevention of diabetes and showed an effective tool for the health education of youth.

All the reviewed articles have a common characteristic as they recognize the risk of diabetes to public health and the need for its prevention. Studies by Schillinger et al. (2018) and Mathe et al. (2017) also overlap in prevention methods such as being active and exercising, although they explore various aspects of diabetes prevention and different age groups. However, the articles have more differences than similarities because they address various issues related to the prevention of diabetes and its complications, which practically do not overlap. Nevertheless, the authors’ findings do not contradict but complement each other, which helps formulate a complete, evidence-based picture of the importance and methods of diabetes prevention.

Thus, all three articles in the sum demonstrate two primary issues. Firstly, diabetes is a global burden disease that increasingly spreads due to structural problems or individual choices. At the same time, its danger includes high morbidity among the population of an increasingly young age and mortality due to complications of diabetes, which in most cases could have been avoided. Secondly, national and international healthcare institutions are still searching for effective methods of prevention and implementation of programs aimed at different groups of the population. As Mathe et al. (2017) and Schillinger et al. (2018) indicate, age groups respond to different stimuli. For this reason, the main task of public health is to develop and select effective measures that will be included in prevention programs to reduce the incidence of diabetes and its complications.

Appraisal of the Evidence to Address the Practice Problem

The selected articles are appropriate for the analysis of the practical problem as they are relevant to its consideration from different perspectives. The authors reveal both the factors influencing the incidence of diabetes and methods of prevention of its complications. The studies have different levels of evidence and types, such as non-experimental research, systematic review, and qualitative research. However, some articles have some shortcomings that have affected the quality of the evidence.

The level of evidence of articles depends on the methods of data collection and analysis, and the studies represent Level I and Level III of evidence. The article by Mathe et al. (2017) is non-experimental research as the authors observed the respondents’ physical activity level in their daily lives and did not manipulate the variables. An article by Schillinger et al. (2018) is a qualitative study in which the authors interviewed respondents and recorded their responses about the factors that contribute to the spread of diabetes and its prevention. Both articles, according to the Research Evidence Appraisal Tool, relate to the Level III of evidence. At the same time, the article by Pham and Nguyen (2019) is a systematic review with Level I of evidence because the studies analyzed are RCTs. Thus, different levels of evidence help to explore the practical problem in detail.

However, while the study of Schillinger et al. is of high quality due to the consistent and detailed description of the purpose, design, results, limitations, and conclusions of the research, the other two articles have some disadvantages (Appendix A). For example, Mathe et al. (2017) used some outdated sources for research and did not discuss instrument validity. At the same time, Pham and Nguyen (2019) did not describe the details of the reviewed studies and how they eliminated inappropriate articles. However, other details such as sample size, consistency of results, and conclusions are of a high level of quality, which allows the use of this evidence to investigate a practical problem.

Moreover, all articles are relevant and necessary for understanding the problem of diabetes and its prevention as they address different sides of the issue. First, these studies help cover different age and social groups, which is essential for the formation of effective prevention programs. Second, the articles describe various complications of diabetes, such as bone fractures and cardiovascular disease and methods of their prevention. In addition, the authors suggest approaches for educating the population, or their findings can be used to develop programs. However, since the topic of diabetes prevention and its complications is vast, additional evidence will be needed to understand the problem fully.


Thus, the study demonstrates that diabetes is a global and national health problem requiring effective prevention programs. The articles by Mathe et al., Pham and Nguyen, and Schillinger et al. describe the main challenges for the development of prevention programs and the consequences of neglecting them, which underline the problem’s significance. Despite some shortcomings, the selected articles have a good and high level of quality of evidence that covers the topic from different perspectives. Nevertheless, a comprehensive study of such a vast topic as diabetes and its prevention requires an analysis of multiple sources.


Ho-Pham, L. T., & Nguyen, T. V. (2019). Association between trabecular bone score and type 2 diabetes: A quantitative update of the evidence. Osteoporosis International, 30(10), 2079–2085.

Mathe, N., Boyle, T., Al Sayah, F., Mundt, C., Vallance, J. K., Johnson, J. A., & Johnson, S. T. (2017). Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes. Canadian Journal of Public Health, 108(4), 355–361.

Schillinger, D., Tran, J., & Fine, S. (2018). Do low-income youth of color see “The Bigger Picture” when discussing type 2 diabetes: A qualitative evaluation of a public health literacy campaign? International Journal of Environmental Research and Public Health, 15(5), 1-14.

Appendix A

Individual Evidence Summary Tool

2. 1. Article Number
Ho-Pham & Nguyen (2019) Mathe et al. (2017) Author and Date
Systematic review with meta-analysis Non-experimental quantitative study Evidence Type
  • 35,546 women and 4962 men aged 30 years and older.

Home-based setting; Scientific databases.

  • People living with type 2 diabetes in Alberta, Canada.
  • Respondent characteristics included a mean age 65.4 years, 46% female,88% married, 54% college education or higher, 39% employed.
  • 166 participants
  • Home-based setting
Sample, Sample Size, Setting
  • The results of the study demonstrated that diabetic patients have a much lower trabecular bone score (TBS) than non-diabetic people, which can explain the higher fracture risks with a higher areal bone mineral density.
  • There was a more significant difference in results for women than men.

People with prediabetes also had significantly lower TBS than non-diabetic people.

  • Adults living with type 2 diabetes are highly sedentary and lack mobility.
  • Activity level is related to gender and employment, since men and unemployed people spend more time for moderate-vigorous physical activity.
  • A high body mass index is associated with a high sedentary time.
  • Only 10% of adults living with type 2 diabetes comply with physical activity guidelines
Findings That Help Answer the EBP Question
  • Trabecular bone score (TBS) –dependent variable.

Age, gender, and ethnicity, diabetes – independent variables.

  • Sedentary behavior, light intensity physical activity (LPA) and moderate-vigorous physical activity (MVPA) – dependent variable.
  • Age, sex, education, marital status, employment status, ethnicity, and smoking status – independent variables
Observable Measures
  • The association between TBS and glucose levels might not be linear.
  • The discrepancy of sample sizes and measurement of variables.
  • Possible accelerometers’ errors such as inability to detect differences between sitting and standing and thresholds used to define intensity levels of activity were not adopted to older adults.
  • Possibly the sample was formed from people inclined to diet and exercise.
Level III of evidence.
Good quality
Level III of evidence.
Good quality
Evidence Level, Quality
Schillinger et al. (2018)
Qualitative research
  • 10 young people of color (15-20 years old).
  • Clinical setting (individual and group interviews
  • The ability to take the initiative and challenge the authorities is a more effective motivator.
  • The main barriers are low income, limited access to healthy food, the imposition of sweet and high-calorie products by advertisements.
  • Individual choice and education are also important for diabetes prevention.
  • Youth of color are more receptive to structural barriers as causes of diabetes.

The Bigger Picture (TBP) campaign is effective in educating youth about diabetes prevention.

  • Participants’ integration of central messages, public health themes, sociological theme, individual and public health literacy – dependent variables.
  • Age, race/ethnicity, income -independent variables.
●One focus group.
●Self-selection of participants.
●Impact of setting and format on the respondents’ answer cannot be accessed.
●Only 9 of 27 videos of the program were watched by participants
Level III of evidence;
High quality
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