Abstract
This proposal focuses on the research study that reveals the association between vitamin D deficiency and diabetes mellitus type 2. Even though these issues have been discussed separately for a long time already, their connection started to be discussed only recently. The proposal is developed based on the PICOT question: are adult patients who have vitamin D deficiency at increased risk for increased severity of diabetes mellitus type 2 compared with adult patients who have no deprivation of vitamin within hospital stay? To answer it, this paper considers the findings of four authoritative peer-reviewed “keeper” articles that are concentrated on the related topics.
They are evaluated and synthesized according to the personally developed tables. The theoretical framework for the research is identified with the emphasis on Rogers’ diffusion of innovations theory, according to which healthcare professionals should implement changes in diabetes treatment and spread the information about the issues associated with vitamin D deficiency. The proposed study is going to be conducted in a hospital in Homestead, FL. The data will be obtained from the medical records of the patients with and without diabetes mellitus type 2 so that their level of vitamin D can be compared. All in all, healthcare providers, patients, educators, and executives are expected to obtain benefits from the findings and generate recommendations.
Vitamin D Deficiency and Diabetes Mellitus Type 2
Not so long ago healthcare professionals started to pay enormous attention to vitamin D because they have identified its connection with a wide range of various diseases, including such critical ones as cancer and heart disease. In addition to that, it was found out that diabetes mellitus type 2 can be caused by the deprivation of this vitamin (Martin & Campbell, 2011). Thus, it can also be presupposed that the treatment focused on reaching sufficient levels of vitamin D is likely to prevent type 2 diabetes in adults. This paper can be extremely advantageous in practice because it can help healthcare professionals to identify those patients who are likely to suffer from diabetes over time.
In addition to that, it can be used to develop more effective treatment than the one that is already generally used. Such intervention would have a positive influence on patients’ condition and the quality of healthcare services because now diabetes is considered to be a critical disease that cannot be treated completely but affects people’s quality of life and leads to adverse health outcomes. Lives on numerous people can be improved because currently a billion people lack vitamin D all over the world, and more than 150 million individuals have diabetes. In the USA only, more than 20 million people have diabetes mellitus type 2, which emphasizes the severity of this problem (Grineva, Karonova, Micheeva, Belyaeva, & Belyaeva, 2013).
Even though different types of the PICOT question could be used to discuss this issue, the proposal is based on etiology because it meets the purpose of the paper better than other variants: Are adult patients (P) who have vitamin D deficiency (I) at increased risk for increased severity of diabetes mellitus type 2 (O) compared with adult patients (P) who have no deprivation of vitamin (C) within hospital stay (T)?
Evidence Review and Synthesis
This paper is written based on 4 “keeper” studies that were maintained by professionals in the sphere of healthcare and published in peer-reviewed journals recently (less than 5 years ago). To select those articles that fit this research, various databases were used. For example, PubMed is known as the US National Library of Medicine National Institutes of Health, Springer, and Hindawi Publishing Corporation.
In their article Alcubierre, et al. (2015) discussed the connection between the level of vitamin D and the severity of diabetes mellitus type 2. They considered that those patients who have vitamin deficiency are more likely to have critical problems with diabetic retinopathy. Professionals identified that there is a lack of knowledge related to this particular issue that is why they gathered two groups of almost 150 patients each and divided them based on the absence and presence of retinopathy. Patients’ condition was assessed by an ophthalmologist to ensure that they meet the criteria. As a result of the study, the authors proved that vitamin D deficiency affects the condition of those individuals who have type 2 diabetes. What is more critical, not only the presence of retinopathy was noticed but also alterations in its severity.
This source is a high-quality article that provides a lot of significant and objective information. The authors did not focus on their personal beliefs but investigated the issue from the very beginning, which allowed them to avoid biases. It was also indicated that no conflict of interest was observed during the research, which enhanced its quality as well. In addition to that, professionals successfully used a range of calculations to perform the results of their analysis and make them as accurate as possible. A lot of variables focused on patients’ conditions were used so that the researchers received an opportunity to discuss the way different characteristics affect health outcomes. The evidence obtained from this source refers to the 3b level. It was gathered through case-control studies, which are rather trustworthy.
The evidence is valuable for this paper because it provides an opportunity to focus not only on the association of vitamin D deficiency with diabetes but also to consider a wide range of patient characteristics. It can be used to speak of the initial condition of the selected sample.
Kostoglou-Athanassiou, Athanassiou, Gkountouvas, and Kaldrymides (2013) focused their work on the influences of different levels of vitamin D on the condition of people with diabetes mellitus type 2. In particular, they discussed the possibility of glycemic control through the control of vitamin D levels. This article is of good quality. It is well-structured, includes explanations, tables with findings, and can be understood without critical problems. The professionals conducted quantitative research, which provided them with the opportunity to provide objective information and obtain particular findings that are not generalized. Being based on the data obtained with the help of case-control studies, it provides the audience with level 3b evidence.
Due to their research, the scientists found out that those patients who suffer from diabetes mellitus type 2 tend to have low levels of vitamin D. In addition to that, its connection with glycemic control was proved. Such conclusions allowed to claim that including vitamin D in treatment interventions, healthcare professionals can improve patients outcomes significantly.
The findings of this article are significant for this paper because they provide an opportunity to find out how diabetes mellitus type 2 can be treated with the help of vitamin D control and to fulfill the project’s objectives in this way. The article is relevant to the specific practice site and population selected for this paper even though it was conducted in another country because the patients had similar health issues and represented adults of both ages.
Similar to Alcubierre et al. (2015), Li et al. (2013) focused their research on the way vitamin D deficiency is connected to a specific point but not type 2 diabetes in general. Professionals discussed diabetic nephropathy in particular. They found out that it is often observed in patients with vitamin D deficiency or its abnormal concentration.
This article turned out to be of high quality because it thoroughly discussed the issue and research maintained by the professionals. All calculations that were needed to fulfill the task of the study were maintained and then described. The authors identified what was done to analyze the data, which proves that they investigated the topic thoroughly. It is rather beneficial that they provided approximate data indicated with the symbol “±”. In this way, they showed that there was a possibility of some, not a critical error. When concentrating on statistics, the authors used percentages but did not express them in round numbers, allowing to notice even slight changes. This article presents level 3b evidence, proving that case-control research is rather popular among professionals who work with such topics and need to obtain lots of information in a relatively short period. It is also possible to use this article as a guideline when adjusting individual patient characteristics.
This evidence is significant for the paper because it supports the ideas provided by other professionals considering the control of vitamin D level. It can be used to support the necessity to investigate the topic and to determine what tests should be obtained at the very beginning of the study.
Just as their colleagues, Usluogullari et al. (2015) described the influence of vitamin D deficiency on type 2 diabetes. In addition to that, much attention was paid to microvascular complications. Even though they are not critical for this paper, the findings regarding them can be used to prove the adverse influence of vitamin D deficiency. The authors concluded that the lack of vitamin D leads to more severe complications of diabetes than those that can be faced when an individual does not suffer from this disease.
This article is of high quality. Just as other sources, it was peer-reviewed by specialists and considered to be good enough for professional usage. The researchers conducted a lot of calculations to obtain quantitative data that is generally considered to be more useful and trustworthy. They discussed patient characteristics and other related variables that provided an opportunity to fulfill the purpose of the paper. Being based on a retrospective cohort study, this source provides level 3 evidence. The work is relevant to the specific population and discussed the issue of interest, which makes it rather useful.
Thus, these four articles provide enough evidence to state that vitamin D deficiency is associated with diabetes mellitus type 2 and presuppose that its increase in the framework of diabetes treatment can be rather beneficial for patients. This evidence refers to level 3, which is strong enough to be used as a source (see Appendices).
Purpose of the Project
This project will be focused on the desire to prove that vitamin D deficiency has an adverse influence on the patient’s condition and leads to severe complications of diabetes mellitus. It will be based on the PICOT question that was described earlier. That is why such objectives will be fulfilled:
- Define vitamin D deficiency and diabetes mellitus type 2;
- Point out the significance of the issue;
- Identify the connection between vitamin D deficiency and diabetes mellitus type 2;
- Offer an intervention to improve the health condition of patients with diabetes mellitus type 2 based on the obtained findings.
As soon as the connection between vitamin D deficiency and diabetes mellitus type 2 within a particular population and site will be proved, the intervention for the enhancement of health conditions will be developed. The possibility of usage of vitamin D in addition to generally prescribed medicines will be considered, and further investigation will be offered for the follow-up studies.
Theoretical Framework
Diabetes mellitus type 2 is not a new disease. It is already discussed by numerous scientists and treated in a particular way. A similar thing can be claimed about vitamin deficiency. However, the influence of the vitamin D level of the development of diabetes and other serious diseases received attention only recently as is not discussed decently yet. Thus, this paper can be supported by Rogers’ diffusion of innovations theory. According to it, innovations can be adopted when their advantages are acknowledged by critical mass.
The proposed research reveals the connection between vitamin deficiency and diabetes as well as recommends some treatment interventions so that its positive influences can be identified and communicated among healthcare professionals. As a result, more professionals will use vitamin D to prevent possible complications and control diabetes mellitus type 2 in adult patients during a hospital stay. Such a theoretical framework is selected because it is likely to fill in the gap in professionals’ knowledge that was identified by different scientists, including Alcubierre et al. (2015), in their works. This work is also expected to trigger other people who work and/or study in the sphere of healthcare to gather and conduct further research studies that can discuss the existing issue in more detail.
Clinical Questions
The clinical question positioned with the help of the PICOT framework presupposes the necessity to conduct a study that allows gathering a range of objective qualitative data that indicates the number of people with and without vitamin D deficiency and the severity of their condition among the patients with diabetes mellitus type 2. The generated PICOT question focuses on the patient’s condition that is affected not only by two variables that can be controlled by the researcher (vitamin deficiency and diabetes) but also by a wide range of other characteristics, such as people’s age, sex, diseases, treatment, etc. That is why it is better to resort to a quasi-experimental study. It can be used even if the control and experimental groups differ in unknown ways, which is extremely advantageous. When conducting a study, the sample will be selected from a limited number of individuals that is why it is significant to avoid lots of exclusion criteria for it. In addition to that, it is not difficult to conduct such studies. They do not require difficult preparation and are not as time-consuming as real experiments, which is beneficial because of the time limitation.
Study Design
As it was already mentioned, the project will be based on the quasi-experimental research study. Being not able to control all variables that affect their health outcomes, such as patients’ characteristics, the researcher will attempt to maintain a kind of experiment. With its help, a causal relationship between vitamin D deficiency and diabetes mellitus type 2 can be identified and described in detail. Even though it is not real research, the independent variable will not be affected, and the control group will be identified. The data needed to maintain this research will be gathered and analyzed using several approaches. The findings will be presented following the same structure that is used for the experimental research study, which will provide an opportunity to submit the paper to a journal and share the information with other professionals, encouraging them to investigate discussed issues and improving their knowledge about it.
Setting and Sample
The setting for the study will be selected, focusing on its location because there will be a necessity to visit this place. In this way, the study will be conducted in a hospital in Homestead, FL. The medical records of the patients with diabetes mellitus type 2 will be obtained to gather data required to conduct this study. Thus, the participants will be those patients who obtain treatment in Homestead’s hospital. In addition to that, only those individuals who had their vitamin D level measured will be included because this point is critical for the findings. In general, random sampling will be used to gather the participants because no other variables will be considered to have a critical influence on the outcomes. Such an approach is also rather beneficial because it provides an opportunity to avoid biases, which makes research more trustworthy, accurate, and objective.
Confidentiality
Even though the researcher will work with medical records, one focuses on the characteristics of human participants. Thus, it is vital to ensure their confidentiality and privacy. For such purposes, no information that can be used to identify a person will be gathered and used in the paper (for example, name or insurance policy number). What is more, much attention will be paid to data processing and sharing. The researcher will ensure that no one except for one has access to this information. A password will be used to prevent undesirable entry, only particular software and hardware will be used to prevent leaks of information. Medical records will not be shown to other people, and patients’ cases will not be discussed with others.
Procedure/Intervention
The research study is going to last for 7 weeks. It will start with the preparation, during which the initial background information needed for the research will be gathered. In addition to that, the tools needed for the streamlined data gathering will be identified. Then, the first part of the study will start with a visit to the setting and selection of medical records. The second part will be dedicated to the identification of vitamin D levels in adult patients without diabetes mellitus type 2. The information needed for the fulfillment of the research objectives will be gathered. Obtained data will be analyzed, and findings described so that it can be stated whether the severity of diabetes and its complications can be reduced with the help of increased vitamin D levels. On this basis, recommendations considering patient treatment will be generated. Finally, the work will be checked and submitted to a journal.
Instruments/Scales and Measurement of Outcomes
The study presupposes the necessity to work with qualitative and quantitative data. Qualitative research will provide an opportunity to gather information needed to support findings and discuss general ideas. Quantitative research will be used to gather the main information. It will focus on the patient characteristics, vitamin D concentration, the presence of diabetes mellitus type 2, and its complications. The data will be compared and analyzed with the help of ANOVA.
Data Collection
Data collection will be maintained while working with medical records of the sample. There will be no necessity to work with the participants in person, which can be rather beneficial because such interactions are rather time-consuming. The data will be collected in an Excel file so that it can be easily accessed but also protected. The fact that the information will be gathered from the medical records but not during personal interaction tends to be advantageous also because it provides an opportunity to avoid a range of biases and misunderstandings.
Considering the PICOT question and the purpose of the research study, there is no necessity to maintain several tests. Before the intervention of the proposed research, only some basic qualitative information will be considered so that the researcher will be able to identify the information that is needed for the study. The data related to the topic will be obtained approximately at the same time in both experimental and control groups because the sample’s condition needs to differ initially.
Data Analysis and Outcomes
The proposed research is going to answer the question: are adult patients (P) who have vitamin D deficiency (I) at increased risk for increased severity of diabetes mellitus type 2 (O) compared with adult patients (P) who have no deprivation of vitamin (C) within hospital stay (T)? To meet this purpose, the researcher will develop a study that is likely to last for about 7 weeks. From the very beginning, one will pay attention to the preparation of required forms and selection of tools needed for data gathering and analysis. The representatives of the hospital that will provide access to patients’ medical records will receive information about the study, including its purpose, objectives, expected outcomes, etc.
As IRB approval will be obtained, the sample will be identified and separated into 2 groups: experimental and control, so that the participants do not differ much. Then, data will be collected, processed, and stored so that no one except for the researcher can access it. The findings are likely to be developed based on this information soon. The recommendations will be developed, and the conclusion will be made so that the results of the research can be observed. The data will be analyzed with the help of ANOVA. At the same time, vitamin D level and the complications of diabetes will be put together so that the connection between them can be vividly seen.
The data will be collected with the help of a sample survey so that it will not be difficult to focus on the part of the patients that share the condition needed for research. The data will be statistically analyzed and presented in the form of percentages to minimalize possible errors. In addition to the information that is critical for the paper, some characteristics of the population will be included so that the researcher will focus on the age and gender of the participants, etc.
Based on the already obtained information, it can be hypothesized that this project will prove that individuals with low vitamin D levels are at increased risk of having diabetes mellitus type 2 and suffer from its negative consequences. As a result, the idea to develop a special treatment based on vitamin intake will be proved and supported. There is a high possibility of including vitamin D intake or/and injection to the general diabetes mellitus type 2 medical intervention. It is expected that patients’ condition can become better in this way.
This study will be beneficial for such stakeholders, as different healthcare providers (doctors and nurses are likely to enhance the quality of health services), patients (improve their health outcomes), educators (share innovative ideas and knowledge, and executives (implement change and support it). Unfortunately, the study may face a range of barriers that prevent its successful implementation. Still, if nurses and doctors are not willing to change their working routine, they can be provided with the report that identifies those positive changes that can be reached if they do so. In addition to that, the executives can implement some policies to affect this situation. Patients may think that vitamins are not strong enough to improve their health condition, but their physicians can make them alter their minds. Educators maybe not willing to discuss innovative treatments with their students, but the presence of this topic in the curriculum will resolve this problem. Finally, executives who do not want to increase expenditures and buy vitamin D can accept the intervention if its benefits are discussed in detail.
References
Alcubierre, N., Valls, J., Rubinat, E., Cao, G., Esquerda, A., Traveset, A.,… Mauricio, D. (2015). Vitamin D deficiency is associated with the presence and severity of diabetic retinopathy in type 2 diabetes mellitus. Journal of Diabetes Research, 7(1): 1-7.
Grineva, E., Karonova, T., Micheeva, E., Belyaeva, O., & Belyaeva I. (2013). Vitamin D deficiency is a risk factor for obesity and diabetes type 2 in women at late reproductive age. Aging, 5(7): 575-581.
Kostoglou-Athanassiou, I., Athanassiou, P., Gkountouvas, A., & Kaldrymides, P. (2013). Vitamin D and glycemic control in diabetes mellitus type 2. Therapeutic Advances in Endocrinology and Metabolism, 4(4): 122-128.
Li, D., Zhang, Y., Ding, B., Liu, B., Jiang, L., Xing, C., & Ma, J. (2013). The association between vitamin D deficiency and diabetic nephropathy in type 2 diabetic patients. Chinese Journal of Internal Medicine, 52(11): 970-974.
Martin, T., & Campbell, K. (2011). Vitamin D and diabetes. Diabetes Spectrum, 24(2): 113-118.
Usluogullari, C., Balkan, F., Caner, S., Ucler, R., Kaya, C., Ersoy, R., & Cakir, B. (2015). The relationship between microvascular complications and vitamin D deficiency in type 2 diabetes mellitus. BMC Endocrine Disorders, 15(33): 1-7.
Appendices
Table 1. Evaluation of “Keeper” Studies.
Table 2. Synthesis of “Keeper” Studies.