Solved: 1 16 Title of Paper Goes Here in Bold Font Student’s Name Goes Here School Affiliatio

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Title of Paper Goes Here in Bold Font

Student’s Name Goes Here

School Affiliation

Instructor’s Name

Date goes here

Title of Capstone Project Goes Here in Bold Font

Discuss the background of your Capstone project. Use a 12-point font and double-space the assignment as per APA guidelines. Indent the first sentence of each new paragraph.

Clinical Problem Statement

Place the week 2 Capstone Topic Summary assignment here, applying any changes as advised by your instructor.

Ans; Type 2 diabetes causes impairment in how an individual’s body controls and uses glucose as fuel. This is a long-term condition that results in excess sugar circulating in the bloodstream, which can cause the development of disorders in the nervous, circulatory, and immune systems. The most suitable intervention for this disorder is to expose the patient to intensive lifestyle interventions through improved lifestyle through proper dieting to keep the sugar levels constant. The qualitative initiative for this disorder is to play the lead role in improving diabetes care quality by deploying real-time feedback with consistent glucose monitoring techniques and coaching on effective dietary practices for reduced carbohydrate consumption for patients with type 2 diabetes (Johansen et al., 2017). The education on this disorder will contribute to improved type 2 diabetes outcomes with fewer scenarios of extreme glucose levels. The patients will improve confidence in regulating an individual’s health, leading to a better quality of life. The inter-professional model of care employed in this case will incorporate various health professionals, including diabetes educators, nurses, pharmacists, dieticians, and family physicians. These professionals will work together towards developing effective strategies to manage diabetes care, offer the necessary services, and make reference to community programs whenever possible (Huang et al., 2016). The place where these interventions will take place is in the healthcare facility.

Description

Type 2 diabetes is a common chronic disease in the United States with a prevalence estimated to affect more than 30 million people accounting for around 9.4% of the United States population (Gillani et al., 2017). As time progresses, the number of individuals with this condition continues to rise steadily, with a steady rate of 1.5 million American adults every year. Although lifestyle modifications and medications are increasing to improve diabetic control, a high proportion of patients contracting diabetes type 2 contribute to advanced contributions. Prolonged exposure to this form of diabetes can progress into many complications, including stroke and heart disease, which arise from induced oxidative stress (Fink et al., 2019). Type 2 diabetes also increases the risk of exposing the patient to microvascular complications such as neuropathy, retinopathy, nephropathy, and kidney failure.

In this case, effective intervention for type 2 diabetes will be intensive lifestyle interventions for the patient, which will involve practitioners working closely with patients to enable them to integrate new diet programs and healthy practices into their lives. This will be done better by coaching, counseling, and providing individualized guidance to the patient to assist them in undergoing successful changes in diet and improving the level of physical activity. The patients must follow up with practitioner’s multiple times during six months or longer (Chatterjee et al., 2017). The dietary elements can include provision with physical activity elements and tailored advice. The intervention will develop nutrition programs that will include a wide range of information, including weight loss goals or other elements associated with weight maintenance or loss.

On the other hand, the qualitative initiative will adopt a patient-centered approach by incorporating the patient preferences numeracy and focusing on addressing the underlying cultural barriers that threaten to compromise the efficiency of the intervention. Also, treatment decisions should be formulated on a timely basis to support critical evidence based on the patient’s comorbidities, preferences, and prognoses (Gummeson et al., 2017). The collaborative efforts will be executed between different practitioners to ensure that the patient will access quality care that will enable them to enjoy a quality life and accomplish their life goals.

Impacts

Diabetes imposes a momentous economic burden on families and society because it is one of the most expensive chronic diseases to treat, including a total cost of $176 billion alone in direct medical costs in 2012 (Aminian et al., 2019). Therefore, enabling the patients to understand the different coping strategies that they can use to improve the quality of their lives will be important in providing a productive workforce and a reduction in healthcare costs. The intensive lifestyle intervention will ensure that the patient can follow up since it is not a strategy that will incur an additional cost from the patient’s pocket. They have to make healthy choices by using the products they already have around their homes. On the other hand, the education programs will play an integral role in improving knowledge on strategies that the organization can use to maintain a steady blood glucose level reduce cardiovascular risk by maintaining an optimum body mass index and managing blood cholesterol. At the same time, the collaboration between different practitioners will increase the opportunity to identify effective measures that will play an integral role in boosting the patient’s overall confidence and wellbeing of the patient.

Significance of the topic and its implication in the nursing practice

The significance of this topic is that it is addressing an issue that is already affecting many people and therefore developing an effective intervention will assist many people to understand effective coping mechanisms and assist the rest of the population on strategies to reduce contracting the disorder (Taheri et al., 2020). The impact of this topic to the nursing practice is that the medical practitioners will be able to accomplish their goals which is to produce a healthy population that is ready to focus on building the economy and nation.

Purpose of the Change Proposal

Discuss the purpose of the change proposal in one to two paragraphs of 4 to 5 sentences at minimum.

PICOT Question

Place the week 3 assignment here, applying any changes as advised by your instructor. Place your PICOT statement/question above the body of this paragraph.

ANSWER

Patient

Currently, the United States has over 37 million citizens who have diabetes which is about 1 in every ten individuals, and about 90.95% of them are suffering from Type 2 diabetes. This type of diabetic disorder is common to people above 45, but more children, young adults, and teenagers have been developing this disorder with time. Reports by the center for disease prevention reveal that the rate of people developing Type 2 diabetes has remained consistent, making many researchers categorize this as an area of concern. In 2015, the disease was ruled out to be the seventh cause of demise across the United States, with evidence revealing that the government is now experiencing a greater burden with the rising medical costs (Bi et al., 2021). diabetes is turning out to be a serious disease. Still, it can be effectively managed through positive lifestyle changes such as proper dieting, participation in physical activities, the appropriate use of insulin, and other medications to aid in regulating blood sugar levels. Another problematic area about diabetes type 2 is that individuals with diabetes are at an increased risk of experiencing serious health complications such as premature death, vision loss, stroke, heart disease, and kidney failure. Worse still, diabetic patient is still at the risk of getting their body organs such as feet, toes, or legs amputated.

Intervention

Developing an effective intervention strategy for type 2 diabetes is important in enabling healthcare practitioners and scholars to identify new opportunities that will bring effective and reliable interventions. In this case, the proposed intervention technique used in managing type 2 diabetes is intensive lifestyle changes for the patient (De Vries et al., 2019). This strategy will be effective and realistic since most hospitals are already awarded robust human resources, capital, and an environment that can support full adoption, implementation, and assessment of the technique. This involves mobilizing nursing practitioners and dieticians to establish techniques that will enable their patients to effectively cope with the new lifestyle changes to provide them with timely and more effective blood sugar control. Another reason why this intervention was selected in this case because the strategy is completely inexpensive since it does not consume a lot of resources and funds. After all, it does not necessitate the patient to purchase a wide array of equipment (Gregg et al., 2012). Apart from that, the healthcare facilities are already supplied with trained personnel who can easily follow up to determine how the clients are coping with the new schedule and how it affects their lives.

Comparison

Another alternative to control this disorder is to use different types of pharmaceutical treatments which work in diverse ways. The pancreas can be encouraged using a diabetes drug to create and release more insulin, restraining the production and dispatch of glucose from the liver, the sensitivity of body cells to insulin is improved, and blocking the activity of the stomach enzymes that reduce carbohydrates. Other ways that these pharmaceuticals work to lower blood sugar levels are by reducing the reabsorption of glucose into the kidneys and slowing down the movement of food throughout the digestive systems. These medications can be consumed orally or be injected directly into the bloodstream (Schmidt et al., 2020). A medicine like Metformin is normally preferred as the first medical preference for treating Type 2 diabetes unless the patient has an underlying condition that limits them from consuming the drug. This medication is safe, effective, and inexpensive, and the risk of cardiovascular attacks have been found reducing. Metformin has other useful impacts on minimizing A1C outcomes, and it may assist with weight management. The drug works by slowing the rate of producing glucose by the liver.

Generally, Metformin is the favored initial medication for treating type 2 diabetes unless there’s an exact reason not to use it. Metformin is inexpensive, safe and effective. It may reduce the risk of cardiovascular events. Other types of pharmaceutical treatment for diabetes type 2 include a sulfonylurea, which comprises various medications, including glyburide, glipizide, and glimepiride. Although these drugs are pretty inexpensive, they may risk triggering low blood sugars and substantial weight gain. Apart from that, insulin sensitizer can also be used, and it is effective and poses zero risks to low blood sugar. Nonetheless, it can contribute to increased weight gain.

Outcome

The intervention selected is using intensive lifestyle changes for diabetes type 2 patients. The outcome of this intervention is that it will focus on improving diabetic care and self-administration behavior among the patients. The intervention begins by recommending physical exercises, an ideal opportunity for overweight patients to manage their weight and maintain a favorable body mass index. This intervention is expected to contribute to a reduction in the number of individuals who are succumbing to the issues linked to weight-related diabetic complications, including cardiovascular disorders and kidney failures (Johansen et al., 2017). Another outcome is that dietary counseling will enable patients to be aware of the substances they should avoid. In this case, patients will be able to identify the substances they should avoid as they contribute to high glycemic value, which triggers increasing blood sugar levels.

Additionally, dietary consultation will offer individuals diverse food alternatives that will help them manage their glucose levels and weight. In addition, social support is important in contributing to behavior change. Thus, it will allow the intervention to empower family members and medical practitioners to support their loved ones living with diabetes by enabling them to cope with their new routines (Huang et al., 2016).

Time

To accomplish these outcomes, it will take 30 days to provide an opportunity for practitioners to observe the patient progress.

Literature Search Strategy Employed

Discuss the literature search strategy that you used to locate your peer-reviewed articles. What data bases and key words did you use? Be sure to include your literature table as an appendix.

Evaluation of the Literature

Place the week 6 assignment here, applying any changes as advised by your instructor.

ANS;

Introduction

Diabetes is a significant health problem that is prevalent in contemporary society. It is a condition characterized by high concentrations of sugar in the blood that is precipitated by either inadequate production of insulin or failure of the bodies of those affected to respond to the hormone (Johansen et al., 2017). It is one of the leading causes of mortalities in the U. S. Therefore, it is necessary to find adequate strategies for managing the condition to reduce its prevalence in society. According to studies, lifestyle modifications are an effective strategy that can reduce sugar levels in patients with diabetes (Huang et al., 2016). Several authors explore the efficacy of lifestyle modification as a strategy for lowering blood sugar levels. This literature review compares the research questions, sample populations, and limitations in different write-ups that discuss the topic. The data compiled will help make conclusions about the study and recommendations for further studies.

Comparison of Research Questions

Different authors used varying research questions to investigate the impact of making lifestyle modifications on patients’ blood sugar levels. Aminian et al. (2019) hypothesized that using metabolic surgery to control the dietary intake of obese patients who have diabetes will help to reduce the concentration of sugar in their blood. The study would test whether this preposition was factual or the data that would be compiled would yield contrary outcomes. On the other hand, the study conducted by Fink et al. (2019) aimed to answer the research question: What are the challenges associated with Type 2 Diabetes, and what changes do individuals make to cope with the condition effectively? The authors focused on compiling views from participants to compile content that would answer this critical question.

Unlike Aminian et al. (2019) and Fink et al. (2019), Gillani et al. (2017) focused on a single population in their investigation. They conducted research that aimed to answer the research question: What lifestyle changes should physically disabled diabetes patients make, and how do they impact their blood sugar levels? Similarly, Taheri et al. (2020) focus on a different population often affected by high blood sugar levels. They used the research question: Does implementing comprehensive lifestyle modifications positively impact young diabetic patients? to explore the impact of lifestyle modification in the lives of patients diagnosed with the condition at an early age. Another practical approach used to compile evidence on the approaches that can help control sugar levels is identifying a specific lifestyle modification technique and determining its effectiveness. For example, Hallberg et al. (2018) focused on answering the research question: What impact does controlling carbohydrate intake in diabetic patients have on glycemic control in patients with diabetes?

Comparison of Sample Populations

The authors use different sample populations to compile data on the topic of lifestyle changes, an intervention that purposes to reduce blood sugar levels in patients with diabetes. While Aminian et al. (2020) used a large sample size of over 13 722 patients, Huang et al. (2016) incorporated only 16 participants. Using a large number of participants is a significant aspect of investigative research. However, when using models such as qualitative studies, researchers often prefer to use a limited study population because of limited funds and the need to compile comprehensive information about a topic. However, all the studies were conducted in healthcare facilities which increases the dependability of the compiled content because the studies were conducted by experts in the medical field.

Comparison of the Limitations of the Studies

The studies exploring the efficacy of lifestyle changes in controlling the blood sugar levels in diabetic patients have different limitations that affect their dependability. For example, the possibility of their being errors such as coding errors, misdiagnosis, and misclassifications are significantly high in the study conducted by Johansen et al. (2017) and Aminian et al. (2019). Another significant limitation of the study is difficulties in confirming whether high glycemic levels precipitated the fatality of patients with diabetes. Another considerable limitation noted in the studies was the failure to incorporate diverse participants in the investigative process. For example, Fink et al. (2019) and Hallberg et al. (2020) included only participants from one region. This interfered with the generalizability of the study because populations such as immigrants were not incorporated into the study. Gilani et al. (2017) also explored a significant limitation experienced during the study. The lack of adequate funds limited the number of participants who could be incorporated into the study. Huang et al. (2016) was limited by the possibility of there being performed biases during the study. These aspects were also factual in the study carried out by Taheri et al. (2019) and Sebire et al. (2018)

Conclusion

A review of the literature shows that lifestyle modification is a significant evidence-based intervention that is guaranteed to elicit positive outcomes when applied in the clinical setting. The studies use different research questions to compile information about various aspects related to the study, such as the impact of the intervention on diverse populations, including the physically disabled and young diabetic patients. Analysis of the sample also shows differences in the number of participants incorporated in the study. However, a notable similarity between the different studies is that they were conducted in healthcare organizations which increases the dependability of the compiled data. Further explorations also show significant limitations that affected the reliability of the studies. Therefore, it is recommended that further studies be carried out to investigate the gaps that the study did not cover, such as the impact of the cultural inclination of patients on the effectiveness of using lifestyle modification as an intervention for controlling blood sugar levels.

Applicable Change or Nursing Theory Utilized

Discuss one of nursing theorist you discussed in the Topic 4 DQ 2 that best fits in with the applicable change of your Capstone Change Project Proposal. This section should be at least two complete paragraphs.

Ans;

On the other hand, Rogers’ change model comprises five essential steps: creating awareness, stimulating interest in an issue, evaluating it, implementing changes, and adopting the new changes in the clinical setting. Rogers change model uses different processes, including creating awareness, triggering interest, evaluating, evaluating, implementing, and adopting changes (Burnes, 2019). The model that is most suitable in implementing the changes in diabetic management is Rogers’ change theory. This is because the steps inherent in the change model will ensure that the effectiveness of the planned changes is proven before they are adopted. For example, during the awareness step, the healthcare providers will be notified about the need to change the approaches used in managing diabetes in the clinical setting.

Proposed Implementation Plan with Outcome Measures

Discuss your proposed implementation plan with outcome measures in no less than two complete paragraphs.

Question; Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?

Discussion of How Evidenced-based Practice was Used in Creating the Intervention Plan

Plan for Evaluating the Proposed Nursing Intervention

Identification of Potential Barriers to Plan Implementation, and How These Could be Overcome

Question; Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers

References

Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., … & Nissen, S. E. (2019). Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. Jama, 322(13), 1271-1282.

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The lancet, 389(10085), 2239-2251.

Fink, A., Fach, E. M., & Schröder, S. L. (2019). ‘Learning to shape life’–a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. International journal for equity in health, 18(1), 1-11.

Gillani, S. W., Sulaiman, S. A. S., Abdul, M. I. M., & Saad, S. Y. (2017). A qualitative study to explore the perception and behavior of patients towards diabetes management with physical disability. Diabetology & metabolic syndrome, 9(1), 1-10.

Gummesson, A., Nyman, E., Knutsson, M., & Karpefors, M. (2017). Effect of weight reduction on glycated haemoglobin in weight loss trials in patients with type 2 diabetes. Diabetes, Obesity and Metabolism, 19(9), 1295-1305.

Taheri, S., Zaghloul, H., Chagoury, O., Elhadad, S., Ahmed, S. H., El Khatib, N., … & Abou-Samra, A. B. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. The lancet Diabetes & endocrinology, 8(6), 477-489.

Bi, S., Ding, X., Yu, S., Guo, B., Mu, L., & Wang, B. (2021). A machine learning model for quantifying the effect of lifestyle interventions for patients with type 2 diabetes mellitus. In Journal of Physics: Conference Series (Vol. 1732, No. 1, p. 012006). IOP Publishing.

De Vries, T. I., Dorresteijn, J. A., Van Der Graaf, Y., Visseren, F. L., & Westerink, J. (2019). Heterogeneity of treatment effects from an intensive lifestyle weight loss intervention on cardiovascular events in patients with type 2 diabetes: data from the Look AHEAD trial. Diabetes Care, 42(10), 1988-1994.

Gregg, E. W., Chen, H., Wagenknecht, L. E., Clark, J. M., Delahanty, L. M., Bantle, J., … & Look AHEAD Research Group, F. T. (2012). Association of intensive lifestyle intervention with remission of type 2 diabetes. Jama, 308(23), 2489-2496.

Huang, X. L., Pan, J. H., Chen, D., Chen, J., Chen, F., & Hu, T. T. (2016). Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. European Journal of Internal Medicine, 27, 37-47.

Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., … & Ried-Larsen, M. (2017). Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Jama, 318(7), 637-646.

Schmidt, S. K., Hemmestad, L., MacDonald, C. S., Langberg, H., & Valentiner, L. S. (2020). Motivation and barriers to maintaining lifestyle changes in patients with type 2 diabetes after an intensive lifestyle intervention (The U-TURN Trial): a longitudinal qualitative study. International Journal of Environmental Research and Public Health, 17(20), 7454.

Be reminded that the reference page is a separate page and should include all references used to develop your Capstone project to include the eight peer-reviewed articles. All resources cited within the body of the assignment should be listed on the reference page. Likewise, all references listed on the reference page, should be cited within the body of the assignment. The reference page is double-spaced throughout and formatted as hanging indent, like this paragraph.

Appendix Section

Appendix section, if tables, graphs, surveys, educational materials, etc. are created (BE SURE TO INCLUDE THE LITERATURE TABLE HERE in addition to any tables, graphs, surveys, education materials, etc. that you created).

Literature Evaluation Table

Student Name:

Change Topic (2-3 sentences): : In patients with type 2 diabetes, is making intensive lifestyle changes compared to using standard procedures only effective in lowering blood sugar levels in thirty days?

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Aminian, A., Zajichek, A., Arterburn, D. E., Wolski, K. E., Brethauer, S. A., Schauer, P. R., … & Nissen, S. E. Published in Jama Journal. https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2019.14231&utm_	Fink, A., Fach, E. M., & Schröder, S. L. Published in the International journal for equity in health. https://doi.org/10.1186/s12939-019-0924-3	Gillani, S. W., Sulaiman, S. A. S., Abdul, M. I. M., & Saad, S. Y. Published in the Diabetology & metabolic syndrome Journal. https://link.springer.com/content/pdf/10.1186/s13098-017-0257-6.pdf	Huang, X. L., Pan, J. H., Chen, D., Chen, J., Chen, F., & Hu, T. T. E. Published in European Journal of Internal Medicine. https://doi.org/10.1016/j.ejim.2015.11.016
Article Title and Year Published	Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. Published in 2019	Learning to shape life’–a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. Published in 2019	A qualitative study to explore the perception and behavior of patients towards diabetes management with physical disability. Published in 2017.	Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis. Published in 2016
Research Questions (Qualitative)/Hypothesis (Quantitative)	Metabolic surgery controls dietary intake to manage blood sugar levels, and reduce the need for medication in diabetic patients who are obese.	What are the challenges associated with a diagnosis of T2D, and what changes do individuals make to cope with the condition effectively?	What lifestyle changes should physically disabled diabetic patients make, and how do they impact their blood sugar levels?	Efficacy of lifestyle interventions in patients with type 2 diabetes: a systematic review and meta-analysis
Purposes/Aim of Study	What lifestyle changes should physically disabled diabetic patients make, and how do they impact their blood sugar levels?	The study aims to deduce the health challenges associated with a diagnosis of T2D and the impact of making lifestyle changes on coping with them	The purpose of the study was to determine whether physically disabled individuals with T2D were aware of the lifestyle management strategies such as changes in dietary intake that they should make to lower their blood sugar levels and improve their health and well-being and the impact of these changes.	The purpose of the meta-analysis is to determine the outcomes of three lifestyle changes: dietary management, increased physical activity, and patient instruction on effective self-care
Design (Type of Quantitative, or Type of Qualitative)	Retrospective cohort design	Descriptive design	Exploratory design	Meta-synthesis design
Setting/Sample	Cleveland clinic/ 13722 patients	Martin Luther-King University Hospital in Germany/ 19 participants	Penang Hospital in Malaysia/21 participants	Online research/ 17 articles
Methods: Intervention/Instruments	Observation of selected patients	Semi-structured interviews using open ended questions	Semi-structured interviews using pen-ended questions	Review of the data in the articles
Analysis	Surgical restructuring of the digestive systems is directly linked to a reduction of blood sugar levels	Patients who changed their lifestyle to incorporate healthy habits experienced low blood sugar levels.	Increased physical activity in physically disabled patients with T2D is directly related to lower blood sugar levels.	Dietary management, increased physical activity and effective education of patients are directly linked to improved health in patients with T2D.
Key Findings	Surgical restructuring of the metabolic system helps reduce the prevalence of cardiovascular problems in obese patients who have diabetes. It also helps control blood sugar levels and reduce medication use in diabetic management	Patients with T2D investigated and found new strategies for coping with the challenges precipitated by a diagnosis of the disease. They also adopted new living styles to improve their health and well-being, which lowered their blood sugar levels significantly.	Patients with T2D investigated and found new strategies for coping with the challenges precipitated by a diagnosis of the disease. They also adopted new living styles to improve their health and well-being, which lowered their blood sugar levels significantly.	Lifestyle modification played a significant role in lowering blood sugar levels and improving the health and well-being of patients with diabetes.
Recommendations	The surgical procedure was a practical approach to improving the lifestyle of diabetic patients who are obese. It led to better dietary management and helped lower the blood sugar levels of patients	Healthcare providers should educate patients on the effective lifestyle changes they can make to improve their health and well-being.	It is necessary to instigate measures to help T2D patients with physical disabilities make adequate lifestyle changes for effective glycemic control	The authors recommended that lifestyle changes should be instructed in diabetic patients to promote their health and well-being.
Explanation of How the Article Supports EBP/Capstone Project	The article is related to the PICOT question because it identifies metabolic surgery as a preparatory step that can be used to change the lifestyle of a diabetic patient to reduce the portions of food they consume and reduce weight, hence controlling their blood sugar levels.	The article is related to the PICOT question because it determines the changes individuals are compelled to make after they are diagnosed with T2D and the impact of these lifestyle changes on their health and well-being.	The article relates to the PICOT question because it explores the lifestyle modifications that diabetic patients who are physically incapacitated make to improve their health and well-being	The article relates to the PICOT question because it discusses practical lifestyle modification approaches that diabetic patients can use and their impact on their blood sugar levels.

Criteria	Article 5	Article 6	Article 7	Article 8
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., … & Ried-Larsen, M. Published in Jamanet Journal. https://jamanetwork.com/journals/jama/article-abstract/2648632	Taheri, S., Zaghloul, H., Chagoury, O., Elhadad, S., Ahmed, S. H., El Khatib, N., … & Abou-Samra, A. B. The Lancet Diabetes and Endocrinalogy Journal. https://jamanetwork.com/journals/jama/article-abstract/2648632	Sebire, S. J., Toumpakari, Z., Turner, K. M., Cooper, A. R., Page, A. S., Malpass, A., & Andrews, R. C. BMC Public Health Journal. https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-018-5114-5.pdf	Hallberg, S. J., McKenzie, A. L., Williams, P. T., Bhanpuri, N. H., Peters, A. L., Campbell, W. W., … & Volek, J. S. Diabetic Therapy Journal. https://link.springer.com/article/10.1007/s13300-018-0373-9 .
Article Title and Year Published	Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Published in 2017.	Effect of intensive lifestyle intervention on body weight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial.  Published in 2020	“I’ve made this my lifestyle now”: a prospective qualitative study of motivation for lifestyle change among people with newly diagnosed type two diabetes mellitus. Published in 2018.	Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study. Publised in 2018
Research Questions (Qualitative)/Hypothesis (Quantitative)	How does lifestyle modification impact the glycemic levels of diabetic patients?	Does implementing comprehensive lifestyle modifications have a positive impact on young diabetic patients?	How do people newly diagnosed with diabetes get the motivation needed to make positive changes in their lifestyle and the impact of these changes on their blood sugar levels	What is the impact of controlling carbohydrate intake having on glycemic control?
Purposes/Aim of Study	The study purposed to investigate the hypothetical indication that modifying patients’ lifestyles helped improve their glycemic levels, lowering their need for medications.	The study aims to investigate whether encouraging lifestyle modifications can help young people with T2D to lose excessive weight and have sufficiently low glycemic levels.	The study aims to determine how individuals diagnosed with T2D get encouraged to make lifestyle changes to control their sugar levels and the impacts of this decision	The purpose of the study is to determine the impact of an intervention designed to restrict carbohydrate intake on the sugar levels of diabetic patients
Design (Type of Quantitative, or Type of Qualitative)	Quasi experimental design	Exploratory study design	Descriptive research design	Randomized control design
Setting/Sample	Zealand and Denmark/98 patients	Qatar/ 158 participants	South West England/ 593 participants	Lafayette, Indiana/218 participants
Methods: Intervention/Instruments	Comparison of the two variables	Semi structured interviews	Semi structured interviews	Comparison of dependent and independent studies
Analysis	Lifestyle changes are directly related to the intensity of the lifestyle changes patients make.	Lifestyle changes are directly related to the intensity of the lifestyle changes patients make.	There is a direct connection between healthy lifestyles and low glycemic levels	There is a direct connection between healthy lifestyles and low glycemic levels
Key Findings	Making lifestyle changes reduced the glycemic levels of diabetic patients; hence they took fewer drugs to control the disease.	Lifestyle modifications helped reduce excessive weight, which is a significant factor in diabetes control. It also reduced glycemic levels hence improving the health of the patients.	The diagnosis of diabetes is a significant motivation that makes them make adequate lifestyle changes to control their blood sugar levels	Limiting carbohydrates intake is a significant intervention that helps in lowering glucose intake in patients with T2D
Recommendations	The authors recommended that diabetic patients be encouraged to make lifestyle changes to improve their health and well-being.	Lifestyle modification should be encapsulated as an effective strategy in managing diabetes because of its short-term and long-term benefits to the patients.	It is significant for individuals diagnosed with T2D to have adequate motivations to make them change their lifestyle, which is a necessary process that ensures that their blood sugar levels are controlled adequately	The researcher indicated that the issue should be investigated more to determine the strategies that can be used to adapt the intervention as an evidence-based practice in the clinical setting
Explanation of How the Article Supports EBP/Capstone	The article is related to the PICOT question because it investigates the relationship between making lifestyle changes and reducing blood sugar levels in diabetic patients and how this impacts their medication use.	The article relates to the PICOT question because it examines the impact of modifying lifestyle on controlling glycemic levels and weight and improving the well-being of patients with diabetes	The article relates to the PICOT question because it investigates how the impacts of making lifestyle changes such as dietary changes and engaging in physical exertions can improve the quality of life of a diabetic patient.	The article is related to the PICOT article because it scrutinizes the effects of using a lifestyle model that comprises approaches such as limiting the intake of carbohydrates in patients with T2D.