Introduction
Individuals at risk for developing type 2 diabetes are provided with helpful dietary and lifestyle recommendations by nurses. The study of the health benefits of low-carbohydrate and ketogenic diets has advanced in nutrition science today. However, limited data compares the effectiveness of ketogenic diets and insulin for weight management. This research paper responds to the PICO question, “for obese patients with diabetes, does a ketogenic diet compared to insulin use decrease HgBA1C levels and aid in weight loss?” The primary objective is to concoct a literature review to establish the best weight-loss intervention in diabetic patients. Equally, this research paper aims to synthesize evidence-based practices in nursing that can equip care providers with the necessary knowledge to educate diabetic patients. In inpatient care optimization and sustained growth of the nursing knowledge base, care providers need to understand the interrelationship between obesity, type 2 diabetes, the ketones diet, and insulin.
A Summary and Statement on Next Steps
There are many overweight or obese individuals with type 2 diabetes mellitus. The researchers appreciate the need to investigate interventions to address the quality of patient management in cases of diabetes and excessive weight gain. The articles provide insights into best practices in using ketogenic diets in weight management among diabetes patients. The interventions are necessitated by the increasing concern over insulin in weight control and the rising cases of diabetes and obese victims. For instance, according to the Centers for Disease Control (CDC), one in ten persons diagnosed with obesity is likely to have Type 2 diabetes (CDC, 2022). As an Advanced Practice Nurse, it is essential to research and discuss with patients appropriate interventions and therapies supported by scientific evidence for various illness processes. In response to the research topic, this article provides an overview of the chosen studies, a critical analysis, a synthesis, and a discussion of the best practices drawn.
Overview of the Studies
The literature search was conducted online for relevant articles on CINAHL, PubMed, and Up-to-date. The keywords used in the research in the databases were weight loss, ketogenic diet, diet, HgA1C, and insulin. The articles selected for the study were based on the level of evidence and the year of publication set at no more than five years old. The selection criteria required that articles are selected based on their design’s strength, results’ reliability, and the extent to which they may be implemented into clinical practice. The selection of articles considered the level of evidence with a preference for more reliable and valid studies depending on the study methods, data analysis techniques applied, and the validity of the derived insights.
The literature search found more than 30 articles relating to the PICO question from the databases. Based on the selection criteria, this literature review chose about five articles that qualified as per the adopted inclusion and exclusion criteria. Based on the section criteria adopted, the process excluded the lower evidence articles, such as opinion reports from authorities and outdated studies published more than five years ago. The review of the studies is organized based on the strengths against the selection criteria and relevance to the PICO question. The following section provides a critical appraisal of the studies highlighting the insights that are important in the synthesis, discussion, and subsequent derived conclusion and recommendations for optimal nursing care for Type 2 Diabetes Mellitus patients.
Critical Appraisal of the Journal Articles
The literature review responds to the research question, “for obese patients with diabetes, does a ketogenic diet, compared to insulin use, decrease HbA1c levels and aid in weight loss?” The need for studies on the insights into the ketogenic diet in patient management is inspired by the prevalence of obesity and diabetes worldwide. Preliminary studies have demonstrated that a ketogenic diet can impair one’s appetite, increasing the rate of fat breakdown and subsequent weight loss. Scientists have proposed the ketogenic diet as an effective way of regulating diabetes and obesity without administering ant drugs or hormones (Arhire et al., 2019). Trends show that compared to insulin administration, the ketogenic diet directly influences HbA1c levels, daily glucose values, and the blood–glucose variability in type 2 diabetes patients.
Synthesis
This synthesis employs descriptive analysis to derive insights from the findings in the critical appraisal. The select articles concur that the ketogenic diet is more advantageous than conventional insulin administration in obese and diabetic individuals as it reverses the adverse effects of insulin resistance in the patient’s body (Lovely Gupta et al., 2018). The findings in the research articles are similar as they aim toward a weight loss initiative in diabetic patients (Lovely Gupta et al., 2018). The population used in the journal articles has similar attributes, as most of the participants were obese patients who had diabetes. It makes comparing data between the two articles easier (Pilla, 2018). Other participants had comorbid conditions such as hypertension in addition to diabetes. The level of evidence in most of the articles was from evidence from well-designed cohort studies.
The validity and reliability of the evidence in the studies are primarily proven by the methodologies adopted to provide the researchers with the necessary information and insights to make informed conclusions. For instance, some studies employed randomized-controlled trials, providing substantial and reliable evidence (McKenzie et al., 2017). In the study, emerging data suggest from the research that dieting may successfully combat obesity. Maintaining lean body mass, essential for gluconeogenesis, is another critical benefit of carbohydrates. Some journal articles critically discussed insulin use in managing diabetes and thus matched the demands of the PICOT question.
The interventions are different in the studies as some advocate for lifestyle modification through exercising; others advocate using insulin, while others advocate using a ketogenic diet. The sample sizes are similar because most participants had diabetes and were obese (Stierman et al., 2021). The patients used are identical to most diabetics globally who have diabetes and intend to lose weight. Through the evidence gained from the research, nurses can adequately advise their patients on the best weight loss strategies to attain weight loss.
The articles make critical correlations between the ketogenic diet and the quality of patient experience in managing quality of life. The researchers provide a detailed discussion of four emerging diagnostic models that may be used in T2DM (McKenzie et al., 2017). The scholarly literature discusses the advantages and disadvantages of using HbA1c to track glucose levels. The scholarly literature discusses the advantages and disadvantages of using HbA1c to track glucose levels (Chehregosha et al., 2019). The researchers focus on how technology can be used to manage T2DM. Despite these differences, these journals enable a reader to understand T2DM better (Pilla, 2018). The researchers demonstrate improved efficiency in ketogenic diet management when technology is appropriately applied to aid decision-making.
The studies make a directly proportional relationship between the ketogenic diet in decrease HgBA1C levels. For instance, scholars observed that consuming fewer carbohydrates causes blood glucose levels to drop, and the body switches its primary energy source from glucose to ketone bodies (McKenzie et al., 2017). With reduced glucose levels, insulin sensitivity also increases. The findings showed that the low-carbohydrate diet was more effective at reducing body fat than the low-fat diet. Both keto and reduced fat diets result in considerable fat loss. This finding supports the use of the ketogenic diet as a treatment for obesity and diabetes and emphasizes the need for more studies examining the diet’s benefits. These findings help address the PICOT question showing ketogenic’s effectiveness in managing T2DM.
The methodologies used in the research articles are reliable for the findings to be incorporated into evidence-based practice. However, articles adopted varied research methodologies and a different number of participants in experimental studies. Despite the differences, the studies show a consistent observation on the impact of the ketogenic diet increases fasting insulin and reduces blood cholesterol levels, enhancing weight loss. Equally, the researchers observe that proper dieting intervention and ketogenic diet management can help reduce or eliminates the need for diabetic medications in patients (Stierman et al., 2021). The insights derived from this descriptive analysis are essential in future studies that may focus on the correlation between T2DM and the ketogenic diet in improving levels of patient satisfaction.
Discussion
Summary of Findings
The studies show that evidence-based methods such as the ketogenic diet reduce the risks associated with obesity and improve health outcomes. The studies show that utilizing Low-carbohydrate, high-fat diets, such as the ketogenic diet, shows promise in helping patients lose weight (Lovely Gupta, 2018). The approach in weight loss management has shown the potential to reverse the signs of metabolic syndrome. It helps in reducing or eliminating insulin requirements for people with type II diabetes, reducing inflammation, improving epigenetic profiles, alter the microbiome. This indicates that the ketogenic diet may benefit weight control and pre-diabetes management. Some physicians promote the diet as a therapy for obesity and a method for controlling pre-diabetes and type 2 diabetes due to its ability to manage blood glucose levels.
Similarly, The researchers recognize the need to discuss any desired food plan with a physician, dietician, or trusted healthcare practitioner, particularly for those attempting to manage a health issue or condition. To guarantee that the keto diet is a safe eating pattern, nurses should effectively explain that anyone interested in beginning the keto diet should contact a physician and determine whether they have diabetes, hypoglycemia, heart disease, or other health issues (Lovely Gupta, 2018). Patients must remember that research on the ketogenic diet’s long-term advantages needs to be revised. It is unknown if sustaining this diet for extended periods is more advantageous than healthier eating practices that are less restricted.
Nurses should emphasize that a ketogenic diet strictly restricts or eliminates carbs. However, certain carbs are beneficial to health. For a less restricted diet, individuals should eat a range of nutrient-dense, fibrous carbohydrates, such as fruits and vegetables, as well as nutrient-dense dairy alternatives and healthy fats (Stierman et al., 2021). Despite the articles’ relevance, reliability, and validity, the extent of the inquiry into psychological suffering from a behavior change is the primary drawback.
Gaps in Knowledge
However, there are gaps in addressing the risks associated with the ketogenic diet and the psychological distress associated with the dietary limitation on the patient’s health. The studies should have addressed the management of patients who have tried and failed to reduce weight with a more balanced distribution of macronutrients. In the studies, VLCKD emerges as an effective therapeutic technique for treating obesity, but there is limited emphasis on the patient’s mental health (Roden & Shulman, 2019). Care providers should be aware that as VLCKD may have a role in predicting T2DM, it is essential to consider it even in patients who are overweight but whose diabetes has been diagnosed with psychological distress (Bril et al., 2019). In inpatient management, after reaching a target weight, it is critical to advise the patient on maintaining it over the long term, including regular exercise and good eating habits such as adhering to the ketogenic diet.
Despite the gaps, the articles demonstrate that in effectively providing patient support, the care providers need to provide patient support in implementing the ketogenic diet in weight management. Studies show that with the drastic reduction in sugar consumption, those on a ketogenic diet are forced to break down their fat stores into molecules known as ketones. Blood ketones serve as a primary fuel source for numerous tissues improving the effect of dieting on weight management (Bril et al., 2019). As such, the ketones diet can provide the necessary intervention in weight loss among patients with diabetes.
Conclusion
For obese patients with diabetes, the ketogenic diet helps decrease HgBA1C levels and aid in weight loss compared to insulin, improving the patient’s quality of life. The studies show that the key objective of the ketogenic diet is to shift the body’s fuel source away from carbohydrates and toward fat. Patients with diabetes benefit significantly from the ketogenic diet because of the high-fat, low-carbohydrate ratio. Obesity is discussed as a worldwide epidemic affecting people of all ages, from toddlerhood to old age. Overweight persons are at increased risk for developing various severe health conditions, including T2DM, cardiovascular disease, and multiple types of cancer. A ketogenic diet is effective for treating obesity because it increases weight reduction and reduces HbA1c levels. The implication helps the nurses better understand their role in preventing diabetes mellitus as a prerequisite for effectively educating the patients on healthy practices to improve their health.
References
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