RCT Appraisal



RCT Appraisal

Introduction

The purpose of this study was to evaluate the effect of self glucose monitoring on glycation of A1c hemoglobin using a blinded randomized clinical trial in patients not receiving insulin therapy. The literature reviewed demanded for randomized control trials, hence this approach was used to document the effects of self glucose monitoring in diabetic patients.

The researchers hypothesized that monitoring of glucose levels does not affect the levels of glycated hemoglobin A1c in patients who are not taking insulin. Since the studies which documented the relation of self glucose monitoring to reduction of glycated hemoglobin levels, no such records were found in case of patients who were on oral hypoglycemic medication regime (Phillips, 2007). The reason described for this discrimination was based on three approaches which include little or no feedback, unawareness or little knowledge of self-adjustment of doses to induce normoglycemia and glucose measurement in fasting rather than postprandial as in order to see the effects of glucose on HbA1c, it is necessary to track the amount of glucose postprandially, so they planned a randomized trial to exclude the influence of the above mentioned deficiencies (Stuart & Roger, 2003). Hence, randomized control trials were the correct method used to see the association with HbA1c in patients not aware of their self regulation regimen and adjustments.

Discussion

Methodology could encompass greater number of people since diabetes is quite prevalent. Although the people assigned in two groups were not equal however the number was close enough to observe the effects of randomization (Stuart & Roger, 2003). The table indicates that only women were included in the study, while the paper does not document any data related to men, hence there is a gap of gender difference that might thrive to explain the physiological differences among the two genders. Type 2 diabetes is a condition that results in impaired metabolism of carbohydrates, fats, and proteins, characterized by hyperglycemia (increased blood glucoe levels).

The pathophysiology of diabetes includes either decreased insulin production or increased peripheral insulin resistance (Roger & Pam, 2008). Decreased production of insulin is the consequence of aging as the beta cells of pancreatic islets decrease in number with aging and insufficient amounts of insulin are produced (DeWayne McCulley, 2005). Insulin is necessary for uptake of glucose by the cells. Insulin not just limited to glucose metabolism, also has effects on protein synthesis and fat metabolism by targeting particular receptors on the cells and inducing certain pathways necessary for protein synthesis and fat metabolism. Primarily, insulin serves to increase or induce the glucose uptake by the cells.

However in certain cases, peripheral visceral cells are unable to show effect to insulin and hence do not uptake the glucose for metabolism. This results in glucose flanking with in the blood unconsumed. This condition termed insulin resistantcne is also characteristic of type 2 diabetes (DeWayne McCulley, 2005). As compared to Type 1 diabetes, which is an autoimmune disease characterised by destruction of pancreatic beta cells, and hence low to no production of insulin, type ...