Evidence-Based Practice and Intervention of Adolescent Patients with elevated Insulin Levels

Transcription

1 Evidence-Based Practice and Intervention of Adolescent Patients with elevated Insulin Levels AN APPROACH TO ACHIEVING PREVENTION OF TYPE II DIABETES MELLITUS BY ALICIA NIX

2 Introduction This presentation explores evidence-based practice to determine the best intervention and the best education for the insulin resistant adolescent to prevent the occurrence of Type II Diabetes.

3 Facts About Insulin Resistance Insulin resistance is the diminished ability of cells to respond to the action on insulin in transporting glucose from the blood stream into the muscles and other tissues. Insulin resistance is the leading cause of type II diabetes according to the CDC Insulin resistance is a preventable disease

4 Background and Significance If Insulin resistance is caught early, it can be reversed. There is no recognized treatment for insulin resistance in adolescents Type II diabetics have insulin resistance for 7-10 years prior to diagnoses

5 PICO Question And Target Population In adolescent years of age that have elevated insulin, what evidence-based interventions most effect insulin levels and future risk for type 2 diabetes.

6 Literature Search Databases included CINAHL, EBSCO and The Cochrane data bases were used. The American Academy of Pediatrics and the CDC website provided additional articles

7 Summary of Evidence The strongest points of the appraisal of the literature suggest that medications, education, diet, and exercise can lower insulin levels. However some of the strongest evidence related specifically to 30 minutes of moderate daily exercise. (an RCT and two Meta-analysis)

8 Recommendations Grade A At risk adolescents with an elevated BMI should be screened for potential insulin resistance at visits to their primary care provider. Those found at risk should have insulin levels drawn. Adolescents with elevated insulin levels will then be given recommendations regarding exercise and diet.

9 Recommendations Grade A Children and adolescents should participate in minutes of physical activity per day regardless of age or race. Exercise reduces insulin resistance in obese children and adolescent. This practice has been shown to reduce visceral fat and insulin resistance. Patients will be contacted weekly to answer any questions and provide encouragement. During these calls, the amount and quality of exercise will be reinforced. This will also be in conjunction with dietary modifications.

10 Recommendations Grade A Insulin levels will be repeated in two months to determine if the levels have improved. This will also include a visit with the primary care provider to address any questions or concerns. This visit will include a evaluation of the patient s height, weight and current BMI.

11 Aim Of Small Test Of Change Decrease insulin levels by 20 % or less over then next two months through implementing exercise recommendations in the pediatric care setting.

12 Insulin-resistant Adolescent

13 Clinical Setting Tennessee Valley Pediatrics located in Tuscumbia,Al Team consists of project leader, Pediatrician (owner), Administrator (owner), two pediatricians, 5 family practice nurse practitioner, two registered nurses, six LPN s, two medical assistants, multiple support staff members. Participants included 14 adolescents age years of age

14 Implementation of STOC IRB approval obtained 2/4/2015 Education presentation for providers and staff completed on 2/13/15 Communicated progress weekly with EBP mentor as indicated Dates of STOC 2/4/15-4/6/15 Pre-intervention population data collected from primary care provider for comparison. 22 patients adolescents diagnosed with insulin resistance in the previous 9 weeks Post-intervention 14 patients who participated in the STOC

15 Implementation of STOC Provided insulin levels pre and post test to the owners of the practice on each participant Documented data on excel spreadsheet and in HER as indicated Made follow-up contact with each participant weekly and reeducated as needed Entered results post-insulin levels on Excel document Evaluated for significance of small test of change Conclusions and recommendations made

16 Evaluation of STOC Patients returned the office for a recheck. BMI and insulin levels were drawn. Utilized the difference in BMI pre and post exercise with the SPSS program. Utilized the difference in pre and post insulin with the SPSS program. Utilized the SPSS program to analyze demographical data in post-intervention adolescents

17 Demographic Variables Race Caucasian African American 57% 42% Results Percent Gender Male Female 42% 57% Age % 14% 7% 14% % 14% 18 21%

18 Results Category 1 grey Pre Insulin Category 1 orange Post Insulin Category 2 grey Pre BMI Category 2 orange Post BMI

19 Conclusion Although not statistically significant, clinical significant in the pre/post intervention in this adolescent population. This indicates a need for exercise recommendation among this population. Educating and follow up phone calls can be lengthy and time consuming. This might provide major challenges in a busy pediatric practice. Most patients were cooperative and receptive to the recommendation and follow up process Checking insulin levels more frequently than every year may not be covered by insurance A larger test size and a larger time frame may have yielded better results

20 Overall Recommendations Obtain insulin levels on adolescents with elevated BMI to determine insulin resistance. Utilize standardized education material on amount of exercise to provide guideline to the patient and the parents. Determine how often insulin levels can be obtained through insurance and determine what ICD10 codes should be used when drawing insulin levels Continue to follow up weekly with patients and parents to provide encouragement and further educate

21 QUESTIONS ANYONE?????????????????????????????????????????????????????????????????????????????????????????????????????

22 References: Quinn, S.M., Baur, L.A., Garnett, S.P.,& Cowell, C.T. (2010, October). Treatment of clinical insulin resistance in children: a systematic review.[journal article]. Obesity Review: An Official Journal Of The International Association For The Study of Obesity,10 (11), doi.org/ /j x x Scott, L.K. (2013,July/August). Presence of type 2 diabetes risk factors in children. [Journal article] Pediatric nursing 39(4), ,180. Retrieved from eds.be.ebscohost.com.spot.lib.auburn.edu/ehost/detail?vid=5&sid=fbda a6d-4932-ace2 CDC provides national estimates, general information on diabetes.(2012).chart 110 (4) 5-8. Retrieved from

23 References Diabetes dateline [Supplemental material].(2011,winter) Diabetes Dateline. Retrieved from wer?sid=8d07d98d-3e e6- d687cfedecf7%40sessionmgr115&vie+11hid=106 Meink,B.M,. & Fineout-Overholt E.(2005) Evidence-Based practice in nursing and healthcare (2 nd.ed). Philadelphia, PA:Wolter Klewer Lippincott Williams and Wilkins. Simmons, S., Alexander,J.L, Ewing H., & Whetzel,S (2012 November 23) SNAP participation in preschool-aged children and prevalence of overweight and obesity [Journal article] Journal of School Health, 12(23), doi.org/10.111/j

24 References Evaluating obesity and cardiovascular risk factors in children and adolescents. (2008). Retrieved June 10, 2014, from Futures/135046/0/Adolescence_11_to_21_Years?amod=aapea&login=tr ue&nfstatus