By SN Ijeoma Amaoji – T2 2020

PICOT/Research question

In adult patients 65 years and older diagnosed with diabetes mellitus admitted to Inova Fairfax

Hospital medical units, how effective are the use of dietary supplements such as cinnamon

compared to medications such as insulin therapy/oral hypoglycemic in the prevention of diabetic

complications within one year period?

PICOT TABLE

P Adult patients 65 years and older with diabetes admitted to Inova Fairfax

Hospital medical units.

Age is one of the most important risk factors for type 2 diabetes with a high

prevalence in older age groups. Selvin and Parrinello (2013), pointed out that

in the USA adults aged 65 or older, had 20% or more than eight times higher

prevalence of being diagnosed diabetes in 2011 than the prevalence among

adults 18 to 44 years of age (2.4% prevalence).

I Dietary supplements like cinnamon.

It is believed that Dietary supplements like cinnamon help patients to control

blood glucose. As mentioned by Hasanzade et al., (2013), traditional herbs

and spices such as Ròu Guì and Cinnamomum cassia are commonly used for

control of glucose among has the greatest effect. They also added that adding

cinnamon to diet can help to lower the glucose level. Studies revealed that

spices such as cinnamon (Ròu Guì; Cinnamomum cassia), and carnation,

walnut, green tea, and mint have similar effects with insulin action in terms

By SN Ijeoma Amaoji – T2 2020

of reduction of sugar level and the most active of them is cinnamon

(Hasanzade et al., 2013).

C Insulin/Oral hypoglycemic medications.

Insulin alone or in addition to oral glycemic medications are universally used

to treat /manage diabetes due to their ability to bring down blood sugar

levels. Research has shown that insulin offers a unique ability to control

hyperglycemia, when used from the time of diagnosis in some circumstances

and when metabolic control is disturbed by medical illness, procedures, or

therapy, and also being used in the longer term ( Home et al., 2014).

O Prevention of diabetic complications. The ultimate goal of diabetes

management is prevention of long-term complications. Uncontrolled

diabetes can lead to a number of short and long-term health complications,

including hypoglycemia, heart disease, nerve damage and amputation, and

vision problems. According to Vinik & Vinik (2003), chronic complications

can be devastating to patients with diabetes mellitus. The major cause of

morbidity and mortality among these patients, are the complications like

Cardiovascular illness, macrovascular disease, with heart attacks, strokes,

and gangrene; and microvascular disease, with retinopathy, nephropathy, and

neuropathy (P. 571).

By SN Ijeoma Amaoji – T2 2020

T Within one year of being diagnosed.

In most cases, people are diabetic for quite a while without knowing before

receiving the actual diagnosis for it. Complications are said to begin to

develop after having diabetes for a number of years. I chose the time of one

year in consideration to the actual length of time they must have developed

diabetes without knowing. There are no set time frame for complications to

start occurring. It all depends on how uncontrolled the management has

been. The duration of diabetes and the degree of glycemic control achieved

are noted to be risk factors for complications (Nickerson & Dutta, 2012).

References

Selvin, E., & Parrinello, C. M. (2013). Age-related differences in glycemic control in diabetes.

Diabetologia, 56(12), 2549–2551. https://doi.org/10.1007/s00125-013-3078-7

Hasanzade, F., Toliat, M., Emami, S. A., & Emamimoghaadam, Z. (2013). The Effect of

Cinnamon on Glucose of Type II Diabetes Patients. Journal of traditional and complementary

medicine, 3(3), 171–174. https://doi.org/10.4103/2225-4110.114900

Home, P., Riddle, M., Cefalu, W. T., Bailey, C. J., Bretzel, R. G., Del Prato, S., Leroith, D.,

Schernthaner, G., van Gaal, L., & Raz, I. (2014). Insulin therapy in people with type 2 diabetes:

opportunities and challenges? Diabetes care, 37(6), 1499–1508. https://doi.org/10.2337/dc13-

2743

Vinik, A. I., & Vinik, E. (2003). Prevention of the complications of diabetes. The American

journal of managed care, 9(3 Suppl), S63–S84. Retrieved from

https://pubmed.ncbi.nlm.nih.gov/12653455/

Nickerson, H. D., & Dutta, S. (2012). Diabetic complications: current challenges and

opportunities. Journal of cardiovascular translational research, 5(4), 375–379.

https://doi.org/10.1007/s12265-012-9388-1