Glycemic Index In Diabetes Management: Nutritionists' Perceptions Surveyed.

Complete a research protocol to address a non-communicable disease topic of your choice. Your research plan should be structured using the following headings:

1. Aims and objectives

2. Background and rationale

3. Research plan

Study design and rationale for its choice

Outcome measure

Exposure measure or Intervention

Study population/Participants, including sample selection and sample size

Analytic strategy to evaluate impact, and proposed statistical approach

5. Anticipated outcomes and significance

6. Proposed timeline 

You may choose any topic area and geographic context you wish, as long as you can justify the public health importance of the health outcome as part of your proposal. You may choose to continue working on the same (or similar) topic area that you addressed in Assignments 1 and/or 2, but this is not imperative. In order to keep the scope and scale of the proposal realistic, you need to ensure that the project can be completed within 3 years.

Aims and objectives

Based on the evidence which has been raised concerning the advantages of using the glycemic index as a means of management of diabetes, it is very crucial to determine the perceptions of the nutritionists on the appropriateness of the use of the glycemic index in the people suffering from diabetes mellitus.

To get a clear understanding of the potential uses of glycemic index in the control of diabetes mellitus.

1. To collect and analyze information concerning the factors associated with the use of the glycemic index in sugar control in patients suffering from diabetes mellitus.
2. To collect and analyze information concerning the factors associated with the non-use of glycemic index in sugar control in patients suffering from diabetes mellitus.
3. To determine the factors that affects the use or nonuse of glycemic index in the control of blood sugar.
4. To find out other possible methods on the basis of the diet, which, can be used to manage and hence prevent the development of diabetes mellitus.

Diabetes refers to a metabolic disorder in which a patient has high levels of sugar in the blood. This leads to several complications in a way that some of them can even lead to the death of a patient (American Diabetes Association, 2014). Some of the complications which arise from diabetes include kidney diseases, cardiovascular diseases (stroke), and blindness. Diabetes is described as a perfect epidemic because apart from being a chronic and noncommunicable disease, it meets all the qualifications for it to be termed as public health disorder (Floegel et al., 2013). The main aim of the all the clinical types of diabetes management is to control the metabolic abnormalities such as the acute low or high glucose levels. Moreover, diabetes management aims at lowering some long term problems such as nephropathy, heart diseases, and retinopathy. In this case, in order to come up with long term complications of both type 1 and type 2 diabetes, the use of the glycemic control is necessary (Greenwood et al., 2013).

First and foremost, nutrition should be given the first priority and this can be termed as being the cornerstone of diabetes management. Nutritional care to diabetic patients aims at enhancing the glycemic control through creating a balance between intake of food and the levels of insulin (Dominguez, 2015). For a long time, glycemic response control has been based on the foods that are rich in carbohydrates such as the use of low carbohydrate diet as well as foods that cause starvation. Other strategies on the basis of carbohydrate control include artificial sweeteners and some pharmacological products like those which block the rapid absorption of carbohydrates and insulin which acts at a faster rate. The use of the glycemic index in controlling the glycemic response has not been used on clinical grounds due to the possibility of mixed meals whose carbohydrate levels might not be known (Moosheer et al., 2014). At the moment, the prevalence of diabetes infection globally is increasing at a steady rate. As a result, there is a need to adopt strategies for prevention of development as well as the treatment of those already living with the condition. Diabetes is also associated with the development of obesity which becomes a risk factor in these patients (Breen et al., 2015). The majority of the complications that arise from diabetes are life threatening to the quality of lives. For instance, approximately 2 deaths caused by heart diseases out of every 3 people suffering from diabetes are common according to the American Diabetes Association (2013). In the United States, heart disease is the major cause of death necessitating the need for focusing on treatment strategies.

Background and rationale

A research survey on the basis of case-control method will be used to determine the effectiveness of glycemic index in blood sugar control in diabetes patients.

The questionnaires used will be semi-structured such that they have a drop and pick an option in order to save time and resources. Moreover, this form of survey tool is important to make data analysis easier to avoid the need for carrying out data entry. This questionnaire will contain both open-ended as well as closed-ended questions which cover all aspects of the study. Moreover, the use of this method of data collection will be based on the fact that most people in the health sector are able to read and write and are more cooperative. In this case, the nutritionists will be sampled from all provincial level general hospitals in Mumbai India. These nutritionists will have to meet a requirement of being active members of the Nutritionist Society of Mumbai.

In this case, all the nutritionists who meet these requirements will be contacted either physically, by telephone or via email on request to participate in the survey. However, student nutritionists, as well as the retired nutritionists, will not be included in this study. The classification of the nutritionists on the basis of a case or control will be upon the counseling sessions offered to diabetes patients and the use of the glycemic index or not. In this case, the nutritionists who counsel diabetic patients using the glycemic index will be classified as the case, while those that counsel diabetes patients using other strategies will be the control group.

Having identified the population, it is important for the researcher to draw a sample from the population. This sample is representative of the population being studied and hence the findings of the sample population can be interpreted on to represent the study population. In this research, random sampling (Csikszentmihalyi and Larson, 2014) will be used to select the participants and a total of 2,600 nutritionists will be targeted to be enrolled in this survey. Having chosen the sample for this study, forms of informed consent will be sent to the study participants electronically. The purpose of the study will be explained to the participants and responses will be promised to be confidential and only compiled together with the views of other participants to make a general conclusion and recommendation. The questionnaires will be sent to the respondents via their email addresses and participants will be asked to submit the filled questionnaires back to the researcher after three days.

Research plan

This survey will be focused on determining the predictor various in glycemic index, professional and sociodemographic information linking the nutritionists and their counseling to diabetic patients on nutrition. The information obtained will help in the identification of those who use and those who do not use the glycemic index (Bhupathiraju et al., 2014). Some of the factors which might influence the use and nonuse of this concept of nutrition in diabetes patients by the nutritionists include age, gender, and the year of graduation from college and the nature of their clinical practice. A user of the glycemic index will be defined as a nutritionist who offers to counsel to diabetes patients and teaches them on the glycemic index. On the other hand, a non-user is a nutritionist who counsels the diabetic patients but does not teach them anything about glycemic index concept.

The responses received from the questionnaires will be entered into Microsoft excel, edited and coded as appropriate. The data will then be exported into SPSS version 17 data analysis software, analyzed and data presented using descriptive statistics such as means, mode percentages, 5-likert scale and standard deviations. The summaries of the results will be visually presented in forms of tables, charts, and graphs. Moreover, multilinear regression model will be used to find the level of use of glycemic index among the diabetes mellitus patients as a diet based control method. While the multi-linear regression controlled the effects on independent variables, it also offered information concerning the effects of independent variables.

For the effective prevention of diabetes, it is important to obtain a high level of glycemic control. This helps in the prevention of other complications which can arise in diabetic people and would complicate the condition. As a result, the nutritionist should adopt the use of the glycemic index as a method of choice in preventing the complications linked with diabetes. It is expected that the glycemic index will be generally get adopted by the nutritionists in Mumbai and spread out to the whole health sector in India to help more specifically the people suffering from diabetes. As common in other surveys, this study is likely to suffer from response bias especially where the respondents might discuss their views when filling the questionnaires. However, the adoption of a case-control design will help the researchers in making a clear distinction between the two respondents. This study will give a clear level on the rate of use of the glycemic index in the control and prevention of diabetes mellitus.

Reference List

American Diabetes Association, 2013. Standards of medical care in diabetes—2013. Diabetes care, 36(Supplement 1), pp.S11-S66.

American Diabetes Association, 2014. Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), pp.S81-S90.

Bhupathiraju, S.N., Tobias, D.K., Malik, V.S., Pan, A., Hruby, A., Manson, J.E., Willett, W.C. and Hu, F.B., 2014. Glycemic index, glycemic load, and risk of type 2 diabetes: results from 3 large US cohorts and an updated meta-analysis. The American journal of clinical nutrition, pp.ajcn-079533.

Breen, C., Ryan, M., Gibney, M.J. and O'Shea, D., 2015. Diabetes-related nutrition knowledge and dietary intake among adults with type 2 diabetes. British Journal of Nutrition, 114(03), pp.439-447.

Csikszentmihalyi, M. and Larson, R., 2014. Validity and reliability of the experience-sampling method. In Flow and the foundations of positive psychology (pp. 35-54). Springer Netherlands.

Dominguez, L.J., 2015. Diabetes-related nutrition knowledge and dietary intake among adults with type 2 diabetes. British Journal of Nutrition, 114(05), pp.829-830.

Floegel, A., Stefan, N., Yu, Z., Mühlenbruch, K., Drogan, D., Joost, H.G., Fritsche, A., Häring, H.U., de Angelis, M.H., Peters, A. and Roden, M., 2013. Identification of serum metabolites associated with risk of type 2 diabetes using a targeted metabolomic approach. Diabetes, 62(2), pp.639-648.

Greenwood, D.C., Threapleton, D.E., Evans, C.E., Cleghorn, C.L., Nykjaer, C., Woodhead, C. and Burley, V.J., 2013. Glycemic index, glycemic load, carbohydrates, and type 2 diabetes. Diabetes Care, 36(12), pp.4166-4171.

Moosheer, S.M., Waldschütz, W., Itariu, B.K., Brath, H. and Stulnig, T.M., 2014. A protein-enriched low glycemic index diet with omega-3 polyunsaturated fatty acid supplementation exerts beneficial effects on metabolic control in type 2 diabetes. Primary care diabetes, 8(4), pp.308-314.