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Evidence-Based Practice Project Paper on Diabetes

Diabetes mellitus is one of the top ten global causes of death (WHO, 2018). In adults, diabetes has a 2-3-fold increase on the risk of cardiovascular complications such as heart attacks and strokes. Scientists have thus been engaged in finding interventions which can be used in the treatment of diabetes. Additionally, various diagnostic tools have been discovered which aid not only in the detection, but also establishment of the most appropriate treatment mechanisms for diagnosis. Various evidence-based articles have been presented on the interventions and diagnostic tools for diabetes treatment. One of those is “Incretin-Based Therapies for Diabetic Complications: Basic Mechanisms and Clinical Evidence” authored by Kawanami, Matoba, Sango, and Utsunomiya (2016) and published in the International Journal of molecular sciences. This article demonstrates that incretin-based therapies such as DPP-4 inhibitors and GLP-1R are beneficial interventions in both the treatment of diabetes as well as preventing any complications which arise from the condition as they attenuate incretin dynamics and thus should be adopted nurse practitioners. This paper focuses on summarizing the article and the implications of its findings for nursing practice.

Article Summary

Research Performed

The aim of the article by Kawanami et al. (2016) was to establish the various pieces of evidence from experiments and clinical trials on the use of incretin-based therapy for the treatment of diabetic complications in adults. In the quest to achieve this primary aim, the authors reviewed a variety of experimental and clinical studies which have been done on incretin-based therapy. In specific, the focus was on the available evidence for the use of incretin-based interventions for treating diabetic nephropathy, macrovasculopathy, retinopathy, and neuropathy. Some of the major physiological incretins which were examined are glucose-dependent insulinotropic polypeptide (GIP) and Glucagon-like peptide (GLP)-1 as well as the current DPP-4 inhibitors and GLP-1R (Kawanami et al., 2016). The impacts of the incretin based-therapies on the various diabetic elements were examined from both experimental studies and clinical studies.

Clinical Findings

In clinical studies done on the specific impact of DPP-4 inhibitors, the results were that DPP-4 activity was high in people with type 1 and type 2 diabetes. Additionally, there was a presence of impaired incretin dynamics in type 2 diabetes. A trial done using Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI 53) demonstrated that there was improved albuminuria by saxagliptin in patients with type 2 diabetes (Kawanami et al., 2016). Generally, it was shown that DPP-4 inhibitors serve to attenuate albuminuria beyond the initial purpose of glucose-lowering. In specific, this study was on pegged on three periods of treatment. One involving sitagliptin taken at 50 mg/day for four weeks and the other alogliptin 25 mg/day for four weeks. The third period involved sitagliptin 50 mg/day for four weeks (Kawanami et al., 2016). The findings of these studies were that GLP-1RA have beneficial effects on albuminuria in type 2 diabetic patients.

                Apart from the attenuating effects of the incretin-based therapies, they were also found to have anti-atherosclerotic effects. In specific, metanalysis done by various authors demonstrates that GLP-1-based therapy are beneficial to the atherosclerotic markers. In specific, they result in reduced death rates arising from cardiovascular causes as well as the incidence of renal or retinal microvascular events. As a result, Kawanami et al. (2016) concluded that incretin-based therapies are beneficial in the treatment of diabetic complications I. However, although the DPP-4 inhibitors and GLP-1RA are similar regarding their pleiotropic effects, their pharmacological actions are different because whereas the former increased the levels of GIP and GLP-1, the latter exert benefits to the DPP-4 substrate (Kawanami et al., 2016).

Significance to Nursing Practice

The findings of the article by Kawanami et al. (2016) have various implications ion nursing practice. In specific, nursing practitioners should now focus on the use of incretin-based therapies as they have been found to be important therapeutic options which have not only provided options for treating diabetes in adults, but also revolutionized the treatment of the condition. In nursing practice, practitioners will be relieved to have found therapies which can be used to ensure that not only are the diabetic complications treated but also any likelihood of cardiovascular complications resulting from the condition. However, nursing practitioners should be wary of the fact that the diversity between GIP and GLP-1 in diabetic in treating complications in diabetes remain unclear. Moreover, further studies will have to be performed with the aim of establishing whether the DPP-4 inhibitors and GLP-1RA when combined can result in better positive effects in the treatment of diabetic patients.

In conclusion, the evidence-based article chosen in this paper has demonstrated that incretin-based therapies such as DPP-4 inhibitors and GLP-1R are beneficial in the treatment of diabetes. After reviewing various experimental and clinical studies, the findings were that DPP-4 inhibitors and GLP-1RA have beneficial effects on the treatment of diabetic complications. Additionally, the authors found out that the incretin-based therapies have revolutionized the treatment of diabetes. The findings provide nurse practitioners with interventions they can use not only to treat diabetes but also prevent any cardiovascular complications which arise from the presence of diabetes.