Evidence Based Practice Paper
Diabetes is a chronic lifelong metabolic condition that affects the regulation of blood glucose levels. It increases the health risks of an affected patient to develop other chronic complications including cardiovascular conditions, kidney disease, glaucoma and neuropathies among other complications. To avoid such complications, early diagnosis, treatment, and proper management are essential. Because of this, researches are continually being done to improve the diagnosis and management of diabetes. The implementation of such research findings in patient care forms the basis of evidence based practice that promotes better quality and safe patient care, which eventually contribute to better outcomes.
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One of such researches is led to the development of a new diagnostic tool that could be used to differentiate between type 1 and type 2 diabetes based on type 1 genetic risk score. The two types of diabetes present in a similar manner but require different treatment approaches (American Diabetes Association, 2017a). Type 1 diabetes is treated using insulin injections whereas type 2 diabetes can be managed using oral anti-hyperglycemic agents as an addition to dieting and physical exercises (American Diabetes Association, 2017a). Initially, type 1 diabetes was associated with children whereas type 2 diabetes was diagnosed in adults. However, with conditions such as obesity, it is difficult to differentiate between the two types of diabetes based on the age of onset. Having a more specific diagnostic tool that differentiates between the two types of diabetes is therefore essential.
The research by Oram et al. (2016) that was carried out at the University of Exeter utilized the genetic variation in type 1 and 2 diabetes in coming up with a tool that could be used to differentiate the two conditions in young adults. The patient population that was used in the study included patients between the ages of 20-40 who had been diagnosed with diabetes. This patient population was more suitable for the research as it is often hard to distinguish type 1 from type 2 diabetes in such a population. Most patients who are diagnosed with diabetes at such age are at risk of starting a plan of care that is not suitable for their type of diabetes, a factor which can compromise on their health outcomes (American Diabetes Association, 2017b).
The researchers developed a genetic risk score based on published type 1 and type 2 diabetes genetic variants and tested in on clinically confirmed patients to determine whether it could differentiate the patients based on their type of diabetes. Using the single nucleotide polymorphism (SNP) genotyping, the genetic components that are strongly associated with type 1 and type 2 diabetes susceptibility were measured. With type 1 diabetes being an autoimmune
disease, human leukocyte antigen (HLA) contains various strong risk and protective alleles that influence the development of type 1 diabetes (Oram et al., 2015). The HLA variants, as well as non-HLA variants, were used to predict the development of type 1 diabetes based on the subsequent genetic risk score (GRS). In the same way, the GRS for type 2 diabetes were determined based on selected 69 SNPs associated with it. They were then used to generate the genetic risk tool to identify both types of diabetes.
The research results indicated that the genetic risk factor could discriminate between the two types of diabetes. The type 1 diabetes GRS had a sensitivity of 50% and a specificity of 95% whereas the type 2 GRS had a sensitivity of 53% and a specificity of 95%. From this, it is evident that the tool can correctly identify those that do not have the condition (Oram et al., 2015). Type 1 GRS predicted the progression to severe insulin deficiency with a 95% confidence interval. From these findings, GRS can help in distinguishing the different types of diabetes. Additionally, it can help identify patients who are likely to develop severe insulin deficiency faster compared to others.
As an evidence based practice guide, the research will impact on the management of diabetes. The best and more effective treatment differs between type 1 and type 2 diabetes. Insulin therapy is essential in treating type 1 diabetes hence the tools differentiate patients who require insulin treatment from those who do not. With the correct diagnosis, the correct treatment therapy is initiated on time. Once insulin therapy is initiated, it cannot be stopped. Hence, it will reduce the numbers of type 2 diabetics who are being treated with insulin unnecessarily (American Diabetes Association, 2017b). Additionally, it will help patients have more understanding of their condition and how to manage it effectively to prevent more adverse health outcomes.
References
American Diabetes Association. (2017a). 2. Classification and diagnosis of diabetes. Diabetes Care, 40 (Supplement 1), S11-S24.
American Diabetes Association. (2017b). 8. Pharmacologic approaches to glycemic treatment. Diabetes Care, 40(Supplement 1), S64-S74.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.
Oram, R. A., Patel, K., Hill, A., Shields, B., McDonald, T. J., Jones, A., ... & Weedon, M. N. (2015). A type 1 diabetes genetic risk score can aid discrimination between type 1 and type 2 diabetes in young adults. Diabetes Care, dc151111.