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Precision in Inquiry: Formulating Research Questions on Type-2 Diabetes and Its Effects Using the PICO Framework

Research Question

The presence of an effective research question is essential in the study as it guides the researchers to determine the protocol and design of the research along with allows to determine the nature of sample to be collected to ensure development of a powerful study (De and Singh, 2019). In the study, through the development of the research question, the facts targeted to be found out is effect of type-2 diabetes on aged individual’s health as well as its influencing on their lifestyle and everyday activities which in turn is affecting their well-being. In order to develop the research question, PICO Framework is to be used according to which the problem, intervention, comparison and outcome to be focused in the research question is to be mentioned (Considine et al. 2017). The problem is referred to the key clinical issue that is highlighted in the study. The intervention is referred to the actions to be adopted by the researcher in the study to resolve the highlighted issues. The comparison is referred to control groups or groups with different intervention used in the study. The outcome is referred to the desired findings required from the study to develop effective decision in managing the identified problem in the study (Casey et al. 2017). The PICO tool is to be implemented in formulating the research question because it allows researcher to develop evidence-based practice (EBP) in collecting answers for the raised questions in the study. Since EBP assist to develop less error in practice, thus PICO tool is appropriate to be used for developing enhanced quality of the study (Harwood, 2019).

The research question of the study is: What are the impact and strategies to manage health and well-being of elderly individuals suffering from type-2 diabetes in the UK?

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Introduction

The Type-2 diabetes is referred as long-term condition which leads the body unable to use insulin in managing proper glucose amount in the body. The condition results the people with type-2 diabetes suffer various negative health consequences and experiences changes in their normal lifestyle that hinders their well-being. In the UK, the elderly people are found to be vulnerably affected by type-2 diabetes that has interfered with their health and well-being (Adapa et al. 2018). Thus, the research proposal is being developed to focus on the topic. In this process, the background and existing information related to the impact of type-2 diabetes on the elderly are to be discussed. Moreover, rationale of the study is to be presented to inform the reason behind the choice of discussion regarding impact of type-2 diabetes on health as well as well-being of elderly in the UK. The research methodology to be used in the further formulation of the study is to be discussed and the way ethical issues and biases are t be managed in the study is to be explained.

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Rationale of the Study

In the UK, there is high prevalence of type-2 diabetes as 90% of the adults are reported to experience the disease (diabetes.co.uk, 2019). As per latest statistics in 2018, half of the people of 65 years and over in the UK are affected by the disease and quarter of the people of 75 years and more in the UK are also affected. This indicates that nearly 10% of the people over the 75 years of age in the UK and 14% o individuals over 85 years are age are suffering from diabetes out of which most of them are affected by type-2 diabetes (bgs.org.uk, 2018). The further statistics available informs that 43% of people between 40-64 years of age are affected by type-2 diabetes in the UK compared to 38.1% of people of 65-79 years and 14.9% of 80 years and over in the UK (statista.com, 2018). It informs that there is high incidence of type-2 diabetes statistics among the elderly in the UK compared to adults.

The rise of type-2 diabetes among the elderly in the UK has become an issue because it is found to hindered impact on their health. As mentioned by Kimball et al. (2017), elderly with type-2 diabetes are seen to show lower efficiency towards wound healing during any sudden cut or bruises. This often leads them to develop ulcer in turn leading to deteriorate their well-being and health. As argued by Joseph and Golden (2017), elderly with type-2 diabetes are often found to be depressed and anxious regarding their condition. This is because the long-term impact of the illness makes them lose zeal towards living life, in turn, making them depressed which leads them to withdrawal from society. Thus, the deteriorated physical and psychological impact of type-2 diabetes on the elderly has made it a major health issue to be resolved so that better health and well-being of the individuals can be promoted.

The rise of type-2 diabetes among the elderly in the UK has currently become an issue as increased surge in the aged population in the UK is seen. This is evident as by 2039 it is reported that 18% of the total population would be aged 65 years and over and 2.4% of the population to be aged 80 years and more (ons.gov.uk, 2017). The study by Thomsen et al. (2018) mentions that with age the pancreatic β cells lead to create lower oxidation of glucose which hinders the body unable to use proper energy by breakdown of glucose in the blood. Thus, the extra glucose gets stored in the blood raising the blood sugar level in elderly in turn making them face T2D. In comparison, the study by Adapa et al. (2018) informs that elderly individual is found to show hindered ion influx management in the body. This result the elderly individuals unable to manage proper operation of potassium and calcium channels required for effective glucose transmission and oxidation in the body. Thus, the hinder ion channel creates insulin resistance in the body with age making elderly being more vulnerable to T2D. Therefore, increased age population would lead to create increased prevalence of type-2 diabetes due to their disruptive physical condition, in turn, worsening the condition. Thus, the study is being developed so that impact of the illness and the way health and well-being of elderly people with type-2 diabetes are to be promoted can be determined.

Background of the Study

The type-2 diabetes is referred to the condition in which the blood sugar of the body is raised as a result of the incapability of the body to use insulin to alter the extra sugar in the blood in the form of the energy to be used by the body or to be stored in the form of glucose in the body (Larsson et al. 2017). The symptoms related to type-2 diabetes include increased thirst as well as hunger, blurred vision, fatigue urination in frequent manner, and others (Fuchsberger et al. 2016). As mentioned by Garcia et al. (2020), in type-2 diabetes the body is unable to use extra glucose in the body in the form of energy to support their normal functioning. This leads the muscles and body to feel low on energy making the person feel fatigued and hungry so that extra food can be taken to fulfil the required demand for energy by the body. As argued by Haak et al (2017), extra sugar present in the blood among the type-2 diabetes patients makes the kidney react towards flushing it out from the body to maintain homeostasis. This leads people with type-2 diabetes feel increased frequency to urinate leading them to be at risk of facing dehydration out of excessive loss of water through urination.

The elderly are mainly referred to the individuals who are 65 years and above living in the communities (Díaz-López et al. 2016). The elderly are more vulnerable to experience type-2 diabetes (T2D) because of the combined effects of hindered functioning of the islet of Langerhans in the pancreas and increased insulin resistance in the body. This is because with age it is seen that GLUT2 which is the key glucose transporter expressed by the β cells of the pancreas that allow large bidirectional flux of dietary sugar and glucose in and out of the cell is reduced. This leads the glucose unable to be used by the cells of the body resulting in increased blood sugar level in elderly with T2D (Ghezzi et al. 2018). The impact of T2D on the elderly is vulnerable and the presence of the illness is seen to cause hindered effect on their heart performance leading to raise cardiovascular disease. This is because increased level of blood sugar due to T2D among the elderly leads to damage the blood vessels by making them contract strongly hindering proper blood flow to the heart. This, in turn, executes dysfunction of the heart making elderly with T2D to face cardiovascular problems such as stroke, high blood pressure and others (Zhang et al. 2018).

In the study by Hjelmgren et al. (2019), it is informed that type-2 diabetes effect on the elderly to make them experience diabetic retinopathy. This is because high blood sugar level in T2D among the elderly for longer time leads to create blockage in the tiny blood capillaries that nourishes the retina of the eye. It leads to cut off required blood flow in the retina making the eye try to develop new blood vessels making individuals face diabetic retinopathy. The rise of diabetic retinopathy in elderly as a result of T2D leads them to face blurred vision making them incapable to take their own care and perform everyday activities. In contrast, the study by Yang et al. (2017) mentions that T2D affects the elderly to develop kidney damage as increased presence of blood sugar in the body accelerates damage to the blood vessels supporting proper functioning of the kidney. This, in turn, hinders the elderly to face deteriorated health condition like kidney failure due to T2D leads to storage of wastes in the body that adversely affects their health.

The existing literature is found to determine some of the impact of type-2 diabetes experienced by the elderly on their physical health. However, there is lack of information in the studies regarding the impact the condition on the mental health and social circumstances of the elderly. In addition, there is lack of information regarding the lifestyle challenges faced by the elderly as a result of type-2 diabetes which adversely affects their health and well-being. Thus, the study will be developed so that further insight into the impact of the condition on the physical and mental health of the elderly as well as their social performance can be developed. Moreover, the challenges faced in lifestyle by the elderly as a result of type-2 diabetes could also be explored through the study and the strategies to resolve them and therefore the study will be performed.

Research Aim

The aim of the study is to dete4rmine the impact of type-2 diabetes on health and well-being of elderly in the UK.

Research Objectives

To determine factors responsible for type-2 diabetes hindering health and well-being of the elderly

To analyse the impact of type-2 diabetes on health and well-being of the elderly in the UK

To critically evaluate challenges experienced due to type-2 diabetes by elderly in the UK

To recommend strategies to resolve the challenges experienced due to type-2 diabetes by elderly in the UK

Methodology

Research Approach

There are two research approaches that are primary research and secondary research. The primary research involves the researcher to gather data directly from the participants in first-hand manner and avoiding inclusion of information from previous studies (Mehta et al. 2017). In contrast, secondary research involves the methodology where the researchers gather existing data and facts from previous studies by summarization of the results present in the study (Steinberg et al. 2017). In this research, secondary research will be used. This is because secondary research has the strength of presenting scientifically approved data from existing studies regarding the research topic (Ried‐Larsen et al. 2019). Thus, using this approach will help the researcher to gather potential evidence regarding the studies that are approved by providing proper relevance with scientific facts.

The strength of secondary research is that it is less time consuming and involves low cost for its execution (Ried‐Larsen et al. 2019). Thus, the secondary research will be used as it will help to allow researcher an easy gathering of information required to execute the study within less time and money. However, the limitation of using secondary research is that due to personal influence of the researcher in expressing the results, therefore, the authenticity, as well as credibility of the results of the study, cannot be assured (Steinberg et al. 2017). The limitation of primary research is that the availability of resource and responses from the participants may hinder the quality of the study (Denova-Gutiérrez et al. 2018). Therefore, the primary research will not be used in performing the research. In addition, primary research is time-consuming and requires increased effort for gathering data (Berard et al. 2018). Thus, it will not be used in executing the study.

Literature Search Strategy

The literature search for the study will be performed by the researchers with the help of electronic database. This is because electronic database contains large number of evidence-based studies which are relevant to selected topic by the researcher. Moreover, electronic database helps to resolve challenges in data collection due to physical or geographical barriers as wide number of online journals and articles written by different authors from over the world relevant to the topic are easily available (Overbeek et al. 2017). The literature search in the study will be performed through Cochrane Library, CINHAL, MEDLINE, Google Scholar and other databases which offers information regarding medical topic. The search terms that will be used in performing the study involve "type-2 diabetes elderly", "type-2 diabetes in the UK", "type-2 diabetes in aged people", "impact of type-2 diabetes on health of aged people" and others. The AND and OR boolean operators will be used in connecting the terms for executing a refined search.

The inclusion criteria are referred to the aspects that are relevant to the study and considered in searching information whereas the exclusion criteria are the factors which are avoided to be included in the study as it hinders the quality and credibility of results in the study (Phelan et al. 2016). The inclusion criteria in the study will be articles that are published on and after 2013, written in English Language, fully –accessible, include information on impact of type-2 diabetes on elderly in the UK and are academic. The exclusion criteria will be journals that are published before 2013, written in language other than English, only abstract available, includes data on impact of type-2 diabetes on health and well-being on adults in other countries. The articles and journals after 2013 will be used as they would include most updated data information regarding the topic, in turn, avoiding to present backdated information that may hinder authenticity of the study. The articles written in languages other than English will be avoided as the researcher are only able to understand English to summarise the results and present the findings properly. The articles focussing on impact of type-2 diabetes on elderly in other countries will be avoided to be included in the study as the current study focuses on the UK as the country where the study is to be organised.

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Ethical and Bias Issues

The Data Protection Act 1998 mentions that no information is to be shared regarding any individual without their prior knowledge and permission (legislation.gov.uk, 1998). Thus, to maintain proper ethics according to the Act the consent from the researcher will be accessed against the papers to the used in executing the study. In case, direct consent cannot be gathered proper reference of the researchers will be mentioned against the data to be shared. In order to maintain beneficence, the researcher’s personal data will not be shared and the details of the participants in the studies if provided would also be avoided to be mentioned in the study. After the analysis of the data is to be done by the researcher, it is to be rechecked by another researcher to ensure personal beliefs have not influenced in interpretation of the results and it is done without any form of personal biases.

References

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Berard, L., Bonnemaire, M., Mical, M. and Edelman, S., 2018. Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey. Diabetes, Obesity and Metabolism, 20(2), pp.301-308.

Casey, M., O'Connor, L., Cashin, A., Smith, R., O'Brien, D., Nicholson, E., O'Leary, D., Fealy, G., McNamara, M., Glasgow, M.E. and Stokes, D., 2017. An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. Nurse education today, 56, pp.35-40.

Considine, J., Shaban, R.Z., Fry, M. and Curtis, K., 2017. Evidence based emergency nursing: designing a research question and searching the literature. International emergency nursing, 32, pp.78-82.

De, D. and Singh, S., 2019. Basic understanding of study types and formulating research question for a clinical trial. Indian dermatology online journal, 10(3), p.351.

Denova-Gutiérrez, E., Muñoz-Aguirre, P., Shivappa, N., Hébert, J.R., Tolentino-Mayo, L., Batis, C. and Barquera, S., 2018. Dietary inflammatory index and type 2 diabetes mellitus in adults: the diabetes mellitus survey of Mexico City. Nutrients, 10(4), p.385.

Díaz-López, A., Bulló, M., Martínez-González, M.A., Corella, D., Estruch, R., Fitó, M., Gómez-Gracia, E., Fiol, M., de la Corte, F.J.G., Ros, E. and Babio, N., 2016. Dairy product consumption and risk of type 2 diabetes in an elderly Spanish Mediterranean population at high cardiovascular risk. European journal of nutrition, 55(1), pp.349-360.

Fuchsberger, C., Flannick, J., Teslovich, T.M., Mahajan, A., Agarwala, V., Gaulton, K.J., Ma, C., Fontanillas, P., Moutsianas, L., McCarthy, D.J. and Rivas, M.A., 2016. The genetic architecture of type 2 diabetes. Nature, 536(7614), pp.41-47.

Garcia, D., Mihaylova, M.M. and Shaw, R.J., 2020. AMPK: Central Regulator of Glucose and Lipid Metabolism and Target of Type 2 Diabetes Therapeutics. The Liver: Biology and Pathobiology, pp.472-484.

Ghezzi, C., Loo, D.D. and Wright, E.M., 2018. Physiology of renal glucose handling via SGLT1, SGLT2 and GLUT2. Diabetologia, 61(10), pp.2087-2097.

Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J.P. and Rayman, G., 2017. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Therapy, 8(1), pp.55-73.

Harwood, L., 2019. Evidence-Based Reviews: Trends in Nephrology Nursing. Nephrology Nursing Journal, 46(2).pp.45-89.

Hjelmgren, O., Strömberg, U., Gellerman, K., Thurin, A., Zetterberg, M. and Bergström, G., 2019. Does retinopathy predict stroke recurrence in type 2 diabetes patients: A retrospective study?. PloS one, 14(1).pp.89-143.

Joseph, J.J. and Golden, S.H., 2017. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Annals of the New York Academy of Sciences, 1391(1), p.20.

Kimball, A.S., Joshi, A., Carson, W.F., Boniakowski, A.E., Schaller, M., Allen, R., Bermick, J., Davis, F.M., Henke, P.K., Burant, C.F. and Kunkel, S.L., 2017. The histone methyltransferase MLL1 directs macrophage-mediated inflammation in wound healing and is altered in a murine model of obesity and type 2 diabetes. Diabetes, 66(9), pp.2459-2471.

Larsson, S.C., Scott, R.A., Traylor, M., Langenberg, C.C., Hindy, G., Melander, O., Orho-Melander, M., Seshadri, S., Wareham, N.J. and Markus, H.S., 2017. Type 2 diabetes, glucose, insulin, BMI, and ischemic stroke subtypes: Mendelian randomization study. Neurology, 89(5), pp.454-460.

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Overbeek, J.A., Heintjes, E.M., Prieto-Alhambra, D., Blin, P., Lassalle, R., Hall, G.C., Lapi, F., Bianchini, E., Hammar, N., Bezemer, I.D. and Herings, R.M., 2017. Type 2 diabetes mellitus treatment patterns across Europe: a population-based multi-database study. Clinical therapeutics, 39(4), pp.759-770.

Phelan, A.L., Kunselman, A.R., Chuang, C.H., Raja-Khan, N.T. and Legro, R.S., 2016. Exclusion of women of childbearing potential in clinical trials of type 2 diabetes medications: a review of protocol-based barriers to enrollment. Diabetes care, 39(6), pp.1004-1009.

Ried‐Larsen, M., Johansen, M.Y., MacDonald, C.S., Hansen, K.B., Christensen, R., Wedell‐Neergaard, A.S., Pilmark, N.S., Langberg, H., Vaag, A.A., Pedersen, B.K. and Karstoft, K., 2019. Type 2 diabetes remission 1 year after an intensive lifestyle intervention: A secondary analysis of a randomized clinical trial. Diabetes, Obesity and Metabolism, 21(10), pp.2257-2266.

Steinberg, W.M., Rosenstock, J., Wadden, T.A., Donsmark, M., Jensen, C.B. and DeVries, J.H., 2017. Impact of liraglutide on amylase, lipase, and acute pancreatitis in participants with overweight/obesity and normoglycemia, prediabetes, or type 2 diabetes: secondary analyses of pooled data from the SCALE clinical development program. Diabetes Care, 40(7), pp.839-848.

Thomsen, S.K., Raimondo, A., Hastoy, B., Sengupta, S., Dai, X.Q., Bautista, A., Censin, J., Payne, A.J., Umapathysivam, M.M., Spigelman, A.F. and Barrett, A., 2018. Type 2 diabetes risk alleles in PAM impact insulin release from human pancreatic β-cells. Nature genetics, 50(8), pp.1122-1131.

Yang, J.K., Wang, Y.Y., Liu, C., Shi, T.T., Lu, J., Cao, X., Yang, F.Y., Feng, J.P., Chen, C., Ji, L.N. and Xu, A., 2017. Urine proteome specific for eye damage can predict kidney damage in patients with type 2 diabetes: a case-control and a 5.3-year prospective cohort study. Diabetes care, 40(2), pp.253-260.

Zhang, H., Zhang, S., Wang, L., Liu, X. and Wu, Y., 2018. Chitooligosaccharide guanidine inhibits high glucose-induced activation of DAG/PKC pathway by regulating expression of GLUT2 in type 2 diabetic nephropathy rats. Journal of functional foods, 41, pp.41-47.

Appendix

Appendix 1
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