NR 505 Week 3: Collaboration Cafe

NR 505 Week 3: Collaboration Cafe

PICOT Question: For females diagnosed with PCOS, how does the initiation of daily inositol supplementation affect insulin resistance evidenced by H1AC in comparison to PCOS females who utilize metformin within 12 months?

Article Website:

1. https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01207-7Links to an external site.

Article Reference:

Zhao, H., Xing, C., Zhang, J., & He, B. (2021). Comparative efficacy of oral insulin sensitizers metformin, thiazolidinediones, inositol, and berberine in improving endocrine and metabolic profiles in women with PCOS: a network meta-analysis. Reproductive health, 18(1), 1-12.

• Description of the purpose

The purpose of this quantitative research is to determine if the improvement of insulin resistance in PCOS can be achieved by the implementation of comparing various insulin sensitizers including inositol and the effects on endocrine and metabolic profiles in women with PCOS.

• Explanation of research design

The randomized controlled trial was composed of 1079 patients. These patients were divided into comparing PCOS patients utilizing inositol in comparison to metformin. The age ranged from women of 14-49 years of age diagnosed with PCOS. The trial was conducted and patients were followed for 12 weeks while measuring desired outcomes from the predefined categories of menstruation, hyperandrogenism, metabolism and insulin resistance. Within the study, they were focused on their lab result evaluation and emphasizing the parameters of total testosterone, sex hormone-binding globulin, androstenedione, glucolipid metabolism, fasting glucose, fasting insulin, homeostatic assessment of insulin resistance, lipids, total cholesterol, and BMI.

• Discussion of sample

The sample was performed by 1079 women ages 14-49 that are diagnosed with PCOS. They used the PICO framework to identify relevant trials that support their research findings.  Combinations of treatment such as metformin, thiazolidinediones, and inositol were implemented in order to identify the best medication or supplement that best supports reducing insulin resistance and other negative side effects of being diagnosed with PCOS. Out of the 1079 patients involved in the sample, 5 trials of 142 women were being evaluated with using inositol, 19 trials were conducted with 455 women with metformin, 10 trials with 280 regarding thiazolidinediones, 3 trials with 89 women utilizing metformin and thiazolidinediones, 1 trial of 26 women implemented berberine and 70 women used metformin and berberine in one trial while the remaining were the control group.

• Description of data collection methods

The various treatment regimens were compared simultaneously using a pairwise meta-analysis. Pairwise meta-analysis is a method that pools evidence from randomized controlled trials that compare multiple interventions. In order to compare multiple interventions to each other, the estimates calculated were pooled estimates of mean differences or odd ratios with 95% confidence intervals. Outside of calculations, Stata software was also used to examine any research bias. As for network inconsistency, they were evaluated using node-splitting method and inconsistency models. The data that was being collected in order to determine effectiveness of treatment regimens were menstrual frequency, hyperandrogenism, obesity, glycometabolism, and lipid levels.

• Summary of findings

In this study, the best intervention was determined by improving results within each category that was preselected to determine treatment efficacy. According to the meta-analysis menstrual frequency, hyperandrogenism, and glycometabolism were improved the best with inositol treatment. As for obesity and lipid levels, the research showed that there were no significant different. Based of this research’s findings, Inositol is deemed to be the best intervention in restoring regular menses and decreasing H1AC while improving insulin resistance. In comparison with metformin that has numerous side effects, inositol is described to have no side effects.

• Strengths of the study

The strength of this study is being able to identify the comparative efficacy and safety of monotherapy versus combination of different oral insulin sensitizers. The strength of the study was being able to provide a comprehensive reference for clinical treatment for women with PCOS.

• Limitations of the study

According to this article, this research has three limitations to the study, The first limitations is the very few reports met the criteria of treatment without contraceptives or intervention of ovulation inducing drugs. The second limitation was the different dosages, durations, and sample sizes of the various medications. Lastly, the third limitation was not accounting for the women who may have dropped out or missed a follow-up.

• Recommendations regarding potential application for future practice that are insightful and appropriate.

Although, the study did not provide reliable and valid data in regard to identifying the clinical outcome of reducing H1AC in PCOS women implementing inositol, this research has started to find evidence towards the desired outcome. This research was able to identify and start the conversation of utilizing alternative supplements without the negative side effects such as the recommended first line of treatment, metformin.

Polycystic Ovary Syndrome (PCOS) is one of the most common causes of female infertility affecting 5 million women in the US (Centers for Disease Control and Prevention, 2022). I have seen many women with PCOS who are often insulin resistant, which increases the risk of type 2 diabetes. Patients with a higher risk of PCOS such as patients with a family history of diabetes usually have a higher level of ALT, AST, and baseline insulin level above 12  μU/mL (Genaazzani et al, 2022). To conclude, patients with a family history of diabetes have a higher risk of liver impairment related to diabetes. 

Centers for Disease Control and Prevention. (2022, August 12). PCOS (Polycystic Ovary Syndrome) and Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/pcos.htmlLinks to an external site.

Genazzani, Battipaglia, C., Semprini, E., Arnesano, M., Ambrosetti, F., Sponzilli, A., Tomatis, V., & Petrillo, T. (2022). Familial Diabetes in Obese PCOS Predisposes Individuals to Compensatory Hyperinsulinemia and Insulin Resistance (IR) Also for Reduced Hepatic Insulin Extraction (HIE). Endocrines, 3(2), 296–302. https://doi.org/10.3390/endocrines3020024

Thank you for shedding light on this topic! As a woman who suffers from Polycystic Ovarian Syndrome or PCOS, and know quite a few women who also suffer from it as well, I can say from personal experience how absolutely FRUSTRATING it is to deal with such a vague illness. PCOS is the most common endocrine disorder that affects reproductive aged women, and with inconsistent diagnostic criteria, coupled with lack of provider knowledge only adds to the challenges of finding effective treatment (Witchel, Teede, & Pena, 2020). I can honestly say it has wreaked havoc on all areas of my life from distorted body image to depression and anxiety and doesn’t include the hormone imbalances.

I will say it is interesting to know that there are other medications that are being used to help treat PCOS, as I personally have only heard of Metformin, and have been told to “just lose weight” which is hard for women with PCOS as that is one of the symptoms, and can I say one of the most annoying symptoms to say the least. I have never heard of utilizing alternative supplements such as Inositol and actually will bring this up to my provider to start a discussion.

Thank you for shedding some light in a dark area!

Doris

Reference

Witchel, Teede, H. J., & Peña, A. S. (2020). Curtailing PCOS. Pediatric Research, 87(2), 353–361. https://doi.org/10.1038/s41390-019-0615-1

I commend your PICOT question that seeks to compare if initiation of daily inositol supplementation in females with PCOS affect insulin resistance compared to those who use Metformin. Going through Zhao et al. (2021), I can confirm that it is a quantitative research that sought to determine if the improvement of insulin resistance in PCOS can be achieved by implementation of comparing various insulin sensitizers including inositol and the effects on endocrine and metabolic profiles in women with PCOS. Indeed, the researchers applied randomized controlled trial (RCT) with 1079 patients. I agree that the participants in the experimental group were treated inositol, while those in the control group were treated with Metformin. I have learned from the article that Inositol is considered as the best intervention in restoring regular menses and decreasing Hb1AC while improving insulin resistance in women with PCOS. It also has a good safety profile. On the other hand, Metformin has numerous side effects, and thus least favorable.

Hello professor and class,

The article I have chosen to write about is called “A nurse practitioner-led telehealth protocol to improve
diabetes outcomes in primary care”

• Description of the purpose

Diabetes is a chronic health condition that affects over 30 million people in the United States and accounts for over $300 billion dollars in healthcare expenditure (Momin et al., 2022). Untreated or poorly managed diabetes can lead to serious consequences. Since the COVID-19 pandemic, the use of telehealth has increased rapidly and has caused a 20% decrease in diabetes related health economic burden (Momin et al., 2022). This study aimed to assess a nurse practitioner led, telehealth supported, diabetes management quality improvement initiative to achieve three outcomes: improvement in patients’ HgbA1c, microalbumin, and estimated glomerular filtration rate (eGFR), improved patient satisfaction with diabetes management, and increased patient attendance to telehealth visits (Momin et al., 2022).

• Explanation of research design

According to the John Hopkins Evidence Appraisal Tool, this study is a level III, nonexperimental study. The study was conducted during a three month time frame and consisted of five interventions: medication management, diet and physical activity, self-management tasks, identification of patient barriers, and monthly goal setting (Momin et al., 2022). An initial, inpatient visit was required with the nurse practitioner to establish a baseline HgbA1c and eGFR and subsequent telehealth visits were conducted between the established nurse practitioner and patient at monthly intervals for a total of three (Momin et al., 2022). During each monthly telehealth appointment, the NP addressed each of the five interventions. 1) The NP questioned the patient’s compliance with their medication regimen, reinforced the importance of medication compliance, and made medication adjustments as necessary (Momin et al., 2022). 2) The NP assessed the patient’s current weight, diet and exercise log, and discussed strategies to improve their regimen as necessary (Momin et al., 2022). 3) The NP discussed the patient’s current foot care routine as well as assessed for any vision or sensory changes noted by the patient (Momin et al., 2022). 4) The NP worked with the patient to establish goals for the next monthly appointment (Momin et al., 2022). 5) The NP discussed potential patient barriers to the interventions and how to overcome them (Momin et al., 2022).

• Discussion of sample

Patients at an unspecified primary care practice in Texas were selected via four criteria: current type 2 diabetes diagnosis with a HgbA1c > 7%, internet access with a device capable of audio-video conferencing, 18 years of age and older, and a current patient of the practice (Momin et al, 2022). All thirty participants signed informed consents to being in the study and were given an option to opt out of the study at any point (Momin et al., 2022).

• Description of data collection methods

A diabetes laboratory panel which included HgbA1c, microalbumin, and eGFR was collected at the end of the study and compared to their results which were collected at the beginning of the study (Momin et al., 2022). Patient adherence to the interventions was measured via percentage of patients who attended each of the three telehealth visits (Momin et al., 2022). Patient satisfaction was collected via the Telehealth Usability Questionnaire (TUQ) satisfaction survey which consisted of 21 agree/disagree questions rated from 1-7 (Momin et al., 2022).

• Summary of findings

Three participants (10%) had an increase in HgbA1c, five participants (17%) had no change in their HgbA1c, and the remaining 22 participants (73%) experienced an improvement in their HgbA1c from their baseline at the start of the study, with 2.3% of these 22 participants dropping their HgbA1c to less than 7 (Momin et al., 2022). For eGFR, 83% of participants experienced an improvement in their eGFR, whereas 10% had no change and 7% experienced a decrease in eGFR (Momin et al., 2022). 57% of patients attended all three monthly telehealth meetings, 36% attended two of the three visits, and 7% only attended one monthly visit, with an overall attrition rate of 16% (5 participants) (Momin et al., 2022).

• Strengths of the study (minimum of 1)

Although a minor proportion of the sample population experienced no change or worsening of their HgbA1c and eGFR levels, approximately 75% of participants made an improvement in their HgbA1c and eGFR levels. Also, according to the TUQ survey, a majority of patients expressed satisfaction with the interventions and were pleased with their interactions with the NPs (Momin et al., 2022).

• Limitations of the study (minimum of 1)

The small sample size and non-random selection of participants in the study limits its external validity (generalizability). Also, financial complications prevented the collection of microalbumin levels for some patients, rendering the study partially incomplete (Momin et al., 2022).

• Recommendations regarding potential applications for future practice that are insightful and appropriate

The findings from the study provide evidence that the use of telehealth with NP provided education measures can improve patients’ self-management of their diabetes. NPs provide valuable assistance for primary care providers in their health education and resource capabilities. As evidenced by the study, NPs provide satisfactory care to patients with diabetes and continue to improve healthcare access to many individuals, particularly in areas with difficult access to healthcare such as rural communities. Also, the use of telehealth for chronic conditions such as diabetes has been shown to be beneficial in promoting positive patient outcomes (Momin et al., 2022). The use of telehealth also helps eliminate certain barriers to access to healthcare such as transportation issues, other medical conditions making it difficult for office visits, and saves time by decreasing time spent in waiting rooms. The findings of this study, however, are difficult to apply to the general population, and further research must be conducted with larger sample sizes and randomization to increase its generalizability.

Reference

Momin, R. P., Kobeissi, M. M., Casarez, R. L., & Khawaja, M. (2022). A nurse practitioner–led telehealth protocol to improve diabetes outcomes in primary care. Journal of the American Association of Nurse Practitioners, 34(10), 1167–1173. https://doi.org/10.1097/jxx.0000000000000759

URL

https://oce-ovid-com.chamberlainuniversity.idm.oclc.org/article/01741002-202210000-00010/HTMLLinks to an external site.

Collaboration Café

Purpose

With new information continually emerging, professional nurses must be equipped to critique scholarly literature and discern its value for practice. Select one current, quantitative scholarly nursing article related to your PICOT question and determine its strengths, limitations, and potential application.

Complete the Johns Hopkins Nursing Evidence-Based Practice Appendix E Evidence Appraisal ToolLinks to an external site. Download Johns Hopkins Nursing Evidence Based Practice Appendix E Evidence Appraisal Tool. Once you’ve completed the tool, use your own words to summarize your appraisal of the article. Include the following:

• Description of the purpose
• Explanation of research design
• Discussion of sample
• Description of data collection methods
• Summary of findings
• Strengths of the study (minimum of 1)
• Limitations of the study (minimum of 1)
• Recommendations regarding potential application for future practice that are insightful and appropriate.

Attach the article to your post, in addition to including the full reference for the article in your post.

During the week, read a minimum of two articles posted by peers and add your thoughts about whether you feel their article would support an EBP change.

 The John Hopkins tool does not need to be turned in, it is a worksheet for you to decide what type of article you have. 

For full credit, submit your initial post by Wednesday at 11:59 PM MT. Complete your two responses to peers by Sunday at 11:59 PM MT.

**To view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.