Running head: IMPROVING GLYCEMIC CONTROL 1

Improving Glycemic Control And Quality Of Life In Adults With Type 2 Diabetes Mellitus

Using Vernonia Cinerea Along With Regular Therapy

Enerolisa Paredes Lixandro

NURS693-F1WW (S18)

Professor Barbara Miville

July 22, 2018

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Improving Glycemic Control And Quality Of Life In Adults With Type 2 Diabetes Mellitus

Using Vernonia Cinerea Along With Regular Therapy

Before the rise of scientific medicine alternative medicine existed, it has been gotten from

numerous procedures, modalities and therapeutic systems that are still new to the larger part of

individuals. Since the early 1980s alternative medicine has become more and more popular, and

although the medical profession does not officially accept it, some doctors do accept that such

methods can be effective in treating some types of illnesses. Complementary and alternative

medicine has increase in popularity, now used by more than 40% of the public (Ventola, C.L.,

2010). Medical schools have begun to teach about alternative medicine practices, hospitals are

creating complementary and integrated medicine programs. Health care insurances are offering

benefits packages that include the services of an alternative practitioner and biomedical research

organizations are investing substantial amounts toward the investigation of these practices.

Conventional medicine has its limitations, since some illnesses are incurable and some

others that are caused by psychological problems cannot be cured by its methods. In contrast,

alternative medicine can be effective in many such circumstances and there is a general

acceptance that its methods can be beneficial. Many people who have not found a solution to

their problem in conventional medicine have resorted to alternative medicine.

PICOT Question

Does Vernonia cinerea along with regular therapy improve glycemic control and quality

of life in adults with Type 2 Diabetes mellitus within 6 to 12 months?

Problem - Glycemic control and quality of life in community dwelling adults with Type 2

diabetes mellitus.
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Intervention - Regular therapy and herbal medicines (Vernonia cinerea)

Comparison - Regular therapy - Medications and Life style modification (diet, exercise)

Outcome - Adequate glycemic control and Better quality of life.

Time – 6 to 12 month

The objective of the study is to investigate the effects of an herbal preparation containing

Vernonia cinerea in patients with type 2 Diabetes. Diabetes is a metabolic disease; it increases

blood glucose levels due to a decreased amount of circulating insulin. This disease leads to

abnormal lipid profiles, and increased free radical production. The study gives a very detailed

description of the background on Diabetes Mellitus. In addition, there is also the mentioning of

traditional herbal medicine use that could be effective in the treatment of diabetes. Several

studies are found as reference showing the effectiveness of different therapies.

Because of the low risks that might come from utilizing this herb, and the findings of the

study. Given the method and the results obtained this could be implemented in some patients.

There was a significant reduction in fasting glucose level and a decrease on Hemoglobin A1C

through out the recordings of the measurements in the study. There are no stated risks and the

benefits are clearly stated. The only reason that would a practitioner from not implementing the

findings is if the herb increases toxicology, or any of the serological measures are abnormal.

Before starting this therapy, it would be clearly explained to patients and family, the risks and

benefits and the measures that would be taken to ensure that no secondary adverse effects are

present.

In order to the project to take effect the EBP mentor will communicate with the

operations manager, the medical director, the research department, the Head provider of the

Endocrinology Department, Diabetes Educator, Registered Dietitian and General Manager of the
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facility. It is important that before the start of the research the head of every department is

informed. Also, the project must be submitted to the internal review board for approval.

Submitting the project is important in order to the results to be published. The best way to inform

the key stakeholder of the project is by setting up a meeting, it will be held in a few weeks with

all of them but first, it is necessary to prepare an agenda, and develop a protocol (Evidence

Based). The EBP mentor will have a meeting with the General Manager to update her on the

project and ask for help in scheduling the meeting.

Based on the study of herbal preparation containing Vernonia cinerea Glucose level,

hemoglobin A1C, total cholesterol and hepatic and renal functions were measure. There was a

positive outcome from the use of diet, exercise and lifestyle modification in conjunction with

herbal supplement. The study used a single center, randomized, placebo controlled cross-over

clinical trial over a 6-month period. Their results demonstrated that there was a significant

decrease of fasting blood glucose and HbA1C levels in diabetic patients. In this study, the

placebo did not decrease glucose levels. They proposed that the presence of n-hexadecaonoic

acid in Vernonia cinerea is what restores the shrinkage of beta cells of islets of Langerhans,

which are in charge of insulin production. In this project the same parameters will be used with a

bigger pool sample. All of the member in charge of the proper conduction of the study will

address the patients’ double blindly to avoid biases. The patients will be divided into two groups,

A and B and will receive the same lifestyle modification and present medication with the only

difference being the receival of the active or placebo pill. The purpose of the project is to obtain

the same results as the study mentioned but applied to a bigger size pool of patients. Given the

results, it will be a benefit to the patients with little to no side effects from the herbal medicine.
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The utilization of the electronic health record is a must for the selection of patients. With

this tool patients that qualify will be matched and screened for the demographics and paraclinical

variables. Also, a randomize algorithm will be created so that a table of random numbers can be

created and each patient will be assigned to one of the two groups. One of the laboratories that

the company uses will be utilized for the course of the research so that no discrepancy is created

in regards to the laboratory blood work recorded.

A clearly defined purpose sets the planning motion in progress. This allows any team

member go back and ensure that they are on course. Based on the appraised evidence, a draft of

the document that lists the outcome is important. This demonstrates the success of the project,

where information will be obtained and who gathers it. After the project is conducted, the most

convenient way to demonstrate the results is through a table. For this, all members involved are

needed to collect the baseline data and create a comparison between them. A preliminary plan is

also created, it should include, the number of staff, the values measured and the difference

between both groups. At the end of the study, if all the serologic measurements of the study for

the patients on Vernonia cinerea are significantly decreased in comparison to the placebo group

the research could be considered a success. Still, further research should be conducted to ensure

quality results and consider Vernonia cinerea a good herbal supplement for patients with

diabetes.

As a summary conclusion, it is important to inform all the parties involved in the study.

These include the stakeholders, staff involved and the internal review board if the study is to be

published. The purpose of the project must be clearly explained and have supporting research in

order to be conducted. It is important to understand the advantages and disadvantages that can

arise and have all members of the research informed, including test subjects. The database and
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screening should be clearly defined to minimize bias or conflicting measurements so that results

are valid and the study can be replicated. Lastly, the outcome of the study most be shown.

Meaning an outcome indicator should be created demonstrating what are the results expected. In

regards to the research proposed, a good indicator that the study was a success is if the

serological values demonstrate a decrease in the studied variables and that no toxicological

measures were present.

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Reference

Fineout-Overholt, E., Williamson, K. M., Gallagher-Ford, L., Melnyk, B. M.,

& Stillwell, S. B. (2011). Following the evidence: Planning for sustainable

change. American Journal of Nursing, 111(1), 54–60.

Gallagher-Ford, L., Fineout-Overholt, E., Melnyk, B. M., & Stillwell, S. B.

(2011a). Implementing an evidence-base practice change. American Journal of

Nursing, 111(3), 54–60.

Sayeed, M. S., Mostofa, A., Ferdous, F. T., & Islam, M. S. (2013). A Randomized,

Placebo-Controlled, Crossover Study of an Herbal Preparation Containing Vernonia

cinerea in the Treatment of Type 2 Diabetes. The Journal of Alternative and

Complementary Medicine, 19(9), 767-771. doi:10.1089/acm.2012.0063

Ventola, C. L. (2010, August). Current Issues Regarding Complementary and Alternative

Medicine (CAM) in the United States: Part 1: The Widespread Use of CAM and the

Need for Better-Informed Health Care Professionals to Provide Patient Counseling.

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20844696