nres part1 edited

8/13/2019 NRES Part1 Edited

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RESEARCH PROPOSAL

Title: FRUITY-VEGS: ALTERNATIVE DIET FOR BLOOD GLUCOSE

CONTROL

Presented by:

BSN 4KAbubakar, Fatima Jonah

Arakama, Nurdalyn J.Anoos, Ericka Christy B.

Aquino, Danielle Dae B.Aquino. Khrysty Rose B.Baginda, Zehara Ann J.Bernante, Jerrybhelle C.

Balajadia, Gee-annCaas, Ralizha Olivia K.

Dequia, Reb CarnellDe Guzman, James DaleDumdumaya, Antoniette

To

Research Committee of theCollege of Nursing

Western Mindanao State UniversityZamboanga City

February 28, 2013


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RESEARCH PROPOSAL

Title: FRUITY-VEGS ALTERNATIVE DIET FOR BLOOD GLUCOSECONTROL

CHAPTER I

BACKGROUND OF THE STUDY/INTRODUCTION

Diabetes is a serious health concern considering it is a pandemic and one of the

top leading causes of mortality in the Philippines based on the 2009 Philippine Health

Statistics. According to International Diabetes Federation (2011) diabetes is fast rising

affecting 300 million people all over the world with about 344 million people at risk ofdeveloping type 2 diabetes. If nothing is done to reverse the epidemic, the International

Diabetes Federation predicts that by 2030, 438 million people will live with diabetes and

almost the same numbers are still unaware that they have Diabetes.

In the Philippines, one out of five Filipinos had diabetes according to Bohol

Standard National Survey 2009. Diabetes mellitus is the 8 th leading cause of mortality in

the country, considering 18% number of annual deaths based on the 2009 Philippine

Health Statistics. According to the World Health Organization study of 2011, the

Philippine is projected to have an estimated number of 7.8 million cases by 2030 and

eventually may rank 9 th in the list of countries with the highest estimated cases

worldwide.

According to American Diabetes Association, diabetes Mellitus is marked by

elevated levels of blood sugar which affects millions of lives and causes a severe health

problem such as damage to the eyes, kidney, heart, peripheral nerves, ulcers on the feet

and amputations.


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However, there are measures on how to prevent diabetes since it is preventable

disease according to American Diabetes Association. It is also mention that the main goal

of diabetes treatment is to normalize insulin activity and blood glucose levels towards

reducing the development of vascular and neuropathic complications. According to the

Diabetes Control Complication Trial there are five components on how to manage

diabetes; exercise, blood glucose level monitoring, pharmacologic therapy, education and

nutritional therapy.

The American Dietetic Association states that nutritional therapy is one of the

most challenging aspects in managing diabetes, considering that one must have a meal plan that keeps the blood glucose at normal level. Healing wonders of diet an effective

guide to diet therapy mention that there are diverse foods in the market that are preferred

for a diabetic individual which are simple to prepare, these foods are also very accessible

in the market. Whole grains, legumes and low fat dairy products, leafy vegetables and

fruits are recommended for diabetic patients.

Fruits and vegetables contribute greatly in the management or even helps prevent

diabetes based on the Healing Wonders of Diet Effective Guide to Diet Therapy.

Considering fruits and vegetables are very high source of fiber that improves blood sugar

control. The U.S National Academy of Sciences, The U.S Department of Agriculture and

The Institute of Medicine all advice to consume 14 grams of fiber per 1000kcal. A study

in the 2000 New England Journal of Medicine revealed that fiber slows the digestion of

foods; it can help blunt the sudden spikes in blood glucose that may occur after a low-

fiber meal. Such blood sugar peaks stimulate the pancreas to pump out more insulin.

National Institute of Health believe that a lifetime of blood glucose spikes could


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contribute to type 2 diabetes which typically strikes after the age of 40, and more than

doubles the risk of stroke and heart disease.

According to the Diabetes control and complications trial, 64% of people having

diabetes are disregarding their meal plans advised by their doctors or dieticians they are

following their meal plan only on the first to second week and after a while they no

longer follow the diet regimen recommended.

It is the researcher s interest and intention to introduce an alternative nutritional

intervention for diabetic clients. It is an alternative, simple and less costly prepared meal

from the most accessible and available fruits and vegetables at the local market. With thatthe study will bring about awareness among food caterers in preparing the nutritional

meals that are good for diabetic clients and non-diabetic as well.

STATEMENT OF THE PROBLEM

The study aims to answer the following questions:

Is there a difference in the blood glucose level before and after the Fru ity-Vegs

Alternative Diet intervention among diabetic clients?

SCOPE AND DELIMITATION OF THE STUDY

This research study will be conducted among known diabetic clients. Limited

only to those who will voluntarily submit to be study participants. Ten female clients will

be taken as study subjects and study duration is 10 days.


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The study focuses on the FRUITY-VEGS ALTERNATIVE DIET intervention that will

be served to study participants during lunch for 5 days. The lunch meal will be in the

form of shake prepared by the researchers themselves.

SIGNIFICANCE OF THE STUDY

The result of the study Fruity -Veg: An alternative Diet for Blood Glucose

Control" will be sinificant to the following:

To The Student Nurses This study will enrich and enable the student nurses at

an early beginning of their clinical practice to explore their future nurses role as a healtheducator and collaborator by giving information and health teaching, and create

awareness about the Fruitie-Vegs Diet intervention for blood glucose control to diabetic

individuals in collaboration with the College of Nutrition and Dietetics.

Clinical Instructors of the College of Nutrition and Dietetics and College of

Nursing The findings of the study may provide references to future related researches on

nutritional interventions.

Participants of the Study: This study is intended for the benefit of diagnosed

diabetic clients as well as the general population afflicted with the disease that they may

become empowered and motivated to continue the "Fruity-Veg Diet" as one of their daily

regimen to control their blood glucose level.

Medical Practitioners: The Fruitie -Vegs Diet will be a great help to the health

care team because it is an natural and modifiable aid in lowering the blood glucose level

of the diabetic individuals but as well as the general population.


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HYPOTHESIS

There is a significant difference on the blood sugar level among the participants

before and after the FRUITY -VEGS DIET intervention.

DEFINITION OF TERMS

The Fruity-Vegs Diet: In the study, it refers to the diet consisting of fruits and

vegetables combined and measured accordingly to meet the ideal daily calorie intake of

diabetic participants.Blood Glucose Control: Refers to a variable that will be influenced by the

intervention of Fruity-Vegs diet and that will result to lowering glucose level that is

within the normal range.

Diagnosed Diabetic client: Refers to the participants in this study that are

officially diagnosed by physicians to have diabetes.

Blood Glucose Test: refers to the measuring of the blood glucose level of the

participants using glucometer before and after the fruity-vegs intervention.

Pre-intervention Blood Glucose: Refers to the blood glucose level of the

participants before the Fruity-Vegs intervention.

Post-intervention Blood Glucose: refers to the blood glucose level of the

participants after the Fruity-Vegs intervention.

2 hour Post Prandial Blood Glucose: is a 2-hour postprandial blood sugar

measuring blood glucose exactly 2 hours after you start eating a meal.


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CHAPTER II

Review of Related Literature

Understanding Diabetes

According to the New Medical Dictionary Manual (2004) diabetes Mellitus is a

type of condition wherein the blood glucose level in our body is not in the average rate. It

occurs when your body cells dont respond appropriately to insulin, and when your

pancreas cant produce enough ins ulin in response.

Pathophysiology of Diabetes

Based on the New Medical Dictionary Manual (2004) the pancreas particularly

the islets of Langerhans secretes insulin and glucagon directly into the bloodstream, that

helps to regulate the blood glucose level within its healthy range so after eating, our

blood sugar rises hence our pancreas detected its rise thus secreting insulin to return the

blood sugar level within its usual range. But if our blood sugar goes down, glucagon is

then secreted to signal the liver to breakdown glycogen into glucose. In the case of

diabetes mellitus, insulin resistance happens. The body cells doesnt function properly in

the presence o insulin. The underlying pathophysiologic defect in type diabetes does not

involved auto immune beta-cell destruction. Rather, type 2 diabetes is characterized by

the following three disorders; Peripheral resistance to insulin, especially in muscle cells

Increased. Altered pancreatic insulin secretion. Increased tissue resistance to insulin

generally occurs first and is eventually followed by impaired insulin secretion.


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The pancreas produces insulin, yet insulin resistance prevents its proper use at the

cellular level. Glucose cannot enter target cells and accumulates in the bloodstream,

resulting in hyperglycemia. The high blood glucose levels often stimulate an increase in

insulin production by the pancreas; thus, type 2 diabetic individuals often have excessive

insulin production (hyperinsulinemia). Over the years, pancreatic insulin production

usually decreases to below normal levels. In addition to hyperglycemia, type 2 diabetic

patients often have a group of disorders that has been called "insulin resistance

syndrome" or syndrome X.

Complications

Complications of Diabetes Mellitus based on the American Diabetes Association are as

follows.

1. Heart and Blood Vessel Disease. Cardiovascular problems like angina pectoris,

heart attack, stroke, high blood pressure and atherosclerosis which can result to

myocardial infarction.

2. Mental Function, Depression and Dementia. Some studies say that diabetic

patients have a much higher risk of developing dementia due to either having

Alzheimers disease or damaged blood vessels in the brain. With depression,

patients tend to be hyperglycaemic, one factor can trigger is due to their illness

condition. Regardless of what age you are, this complication can be triggered if

left untreated.

3. Nerve Damage (neuropathy). There are 2 types of neuropathy:


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a). Peripheral Neuropathy (which affects the sensation in the toes, feet, legs,

hands, and arms). This has the stocking-glove contribution. A tingling

sensation, weakness, burning sensation, loss of sense in warm and cold

water, numbness (if nerves are severely damaged), and deep pain are some

symptoms present.

b). Autonomic Neuropathy (which affects the nerves that helps in regulating

the digestive system, bowel and bladder control, heart, and sexual

function)= Constipation, Diarrhea, Nausea, Vomiting are digestive

problems contributed by diabetes. Incontinence in the bowel and bladderoccurs. Rapid heart rates, Orthostatic Hypotension when standing up also

occurs.

4. Kidney Damage (Nephropathy). Diabetes damages the glomeruli (tiny filters in

the kidney) causing the protein to leak into the urine. End-Stage Renal Disease

(ESRD) occurs with patients with diabetes.

5. Eye Complication and Retinopathy. Diabetes can cause damage in the blood

vessels of the retina (diabetic retinopathy) leads to blindness. This is a

common disorder to diabetic patients, cataracts and glaucoma may also be

present.

6. Diabetic Ketoacidosis (DKA). This complication is life threatening brought

about by insulin deficiency. Causes of DKA are not clear.

7. Osteoporosis.

8. Sexual dysfunction. Men with diabetes, smokers in particular, can damage the

blood vessels and nerves which lead to erectile dysfunction. Meanwhile


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women with diabetes will have a reduced pleasure from sex, reduced orgasm

ability, vaginal dryness, painful sex, and loss of sex drive.

9. Hypoglycemia. As we all know, diabetes requires a strict blood glucose

control. Hypoglycemia is also known as insulin shock, this occurs if blood

glucose depreciates beyond its normal level. Occasionally, this complication is

manageable.

10. Hearing loss.

11. Skin and foot complications. Infection can be present.

Statistic of Diabetes Mellitus

Globally diabetes is past rising. Diabetes is a leading threat to global health and

development. According to International Diabetes Federation 2011, diabetes now affects

over 300 million people all over the world. A further 344 million people are at risk of

developing type 2 diabetes, the most common form of the disease. If nothing is done to

reverse the epidemic, International Diabetes Federation predicts that by 2030, 438 million

people will live with diabetes.

The National total cases of diabetes are 25.8 million children and adults in the

United States which 8.3% of the population has diabetes. Diagnosed with diabetes about

18.8 million people and Undiagnosed people of 7.0 million. Prediabetes 79 million

people.

1.9 million new cases of diabetes are diagnosed in people aged 20 years and older

in 2010.


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1. Under 20 years of age - 215,000, or 0.26% of all people in this age group have

diabetes and about 1 in every 400 children and adolescents has diabetes

2. Age 20 years or older- 25.6 million, or 11.3% of all people in this age group

have diabetes.

3. Age 65 years or older- 10.9 million, or 26.9% of all people in this age group

have diabetes

4. Men-13.0 million, or 11.8% of all men aged 20 years or older have diabetes

5. Women - 12.6 million, or 10.8% of all women aged 20 years or older have

diabetes

Morbidity and Mortality

In 2007 National Health Statistics, diabetes was listed as the underlying cause on

71,382 death certificates and was listed as a contributing factor on an additional 160,022

death certificates. This means that diabetes contributed to a total of 231,404 deaths.

Philippines is one of the incre asing cases of diabetes which is the so called High

sugars. Its incidences are rising in the Philippines. One out of five Filipinos in the

Philippines had diabetes according to Bohol standard. National survey of the government

in 2009 and it is found that 3.9 percent of Filipinos were diabetic compared to the latest

survey that 20.6 percent of adults aged 30 and above has found to have diabetes in the

year 2007. Diabetes mellitus is the ninth leading cause of mortality in the country based

on the 2003 Philippine Health Statistics. Diabetes mortality rate has increased by 92%

over a ten year period from 1986 to 1995 and it is estimated that there are currently 3

million Filipinos who are diabetic. Based on the WHO study (2011), the Philippines is


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projected to have an estimated number of 7.8 million cases by 2030 and eventually may

rank ninth in the list of countries with the highest estimated cases worldwide

MANAGEMENT AND TREATMENT

According to American Diabetes Association the major goal in treating diabetes is

to minimize any elevation of blood sugar (glucose) without causing abnormally low

levels of blood sugar. Type 1 diabetes is treated with insulin,exercise, and a diabetic diet.

Type 2 diabetes is treated first with weight reduction, a diabetic diet, and exercise. When

these measures fail to control the elevated blood sugars, oral medications are used. If oralmedications are still insufficient, treatment with insulin is considered.

Adherence to a diabetic diet is an important aspect of controlling elevated blood

sugar in patients with diabetes. The American Diabetes Association has provided

guidelines for a diabetic diet. The American Diabetes Association diet is a balanced,

nutritious diet that is low in fat, cholesterol, and simple sugars. The total daily calories

are evenly divided into three meals. In the past two years, the American Diabetes

Association has lifted the absolute ban on simple sugars. Small amounts of simple sugars

are allowed when consumed with a complex meal.

The Institute of Medicine of the National Academy of Sciences (2000) suggest

that weight reduction and exercise are important treatments for diabetes. Weight

reduction and exercise increase the body's sensitivity to insulin, thus helping to control

blood sugar elevations.
http://www.medicinenet.com/script/main/art.asp?articlekey=47883http://www.medicinenet.com/script/main/art.asp?articlekey=320http://www.medicinenet.com/script/main/art.asp?articlekey=320http://www.medicinenet.com/script/main/art.asp?articlekey=47883


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DIETARY MANAGEMENT

Medical Nutrition Therapy

The American Diabetes Association introduced Medical Nutrition Therapy in 1999 to

better articulate the national therapy process. It is defined as the use of specific nutrion

services to treat an illness, injury or condition and involves two phases; Assessment of

Nutrional Status of the client and treatment, which includes Nutrition Therapy,

Counseling and the use of specialized nutrition supplements. MNT for Dm incorporates

a process that when implemented correctly, includes an assessment of the patientnutrition and diabetes self management, knowledge and skills, identification and

negotiation of individually designed nutrition goals, nutrition intervention including a

careful match of both meal- planning approach and educational materials to the patients

need, with flexibility in mind to have the plan be implemented by the patient and

evaluation of outcomes and ongoing monitoring. These 4 steps are necessary to assist

patients in acquiring and maintain the knowledge, skills, attitude, behaviour and

commitment to successfully meet the challenges of daily diabetes self management.

The American Diabetes Association Guidelines on MNT are as follows.

For Carbohydrates

The American Diabetes Association agrees that a dietary pattern that includes

carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk should be

encouraged. There is also overall agreement that for individuals with Type 1 Diabetes

Mellitus,insulin therapy should be integrated into the dietary and physical activity


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pattern, and that the key to successful Medical Nutrition Therapy is synchronizing

carbohydrate intake with insulin therapy. The guideline developers further agree that

carbohydrate intake should be kept consistent on a day-to-day basis with respect to time

and amount, and that for individuals who are on insulin pump therapy, insulin doses

should be adjusted based on the carbohydrate content of meals and snacks.

Protein

The guideline groups agree that protein intake in individuals with diabetes mellitus and

normal renal function should be the same as for patients who do not have diabetesmellitus, 15% to 20% of daily energy intake. American Diabetes Association adds that

protein should not be used to prevent or treat acute nighttime hypoglycemia in

individuals with Type diabetes Mellitus, and that high-protein diets are not recommended

as a method for weight loss at this time.

Fiber

American Diabetes Association notes that, as for the general population, people with

diabetes are encouraged to consume a variety of fiber-containing foods. They add,

however, that evidence is lacking to recommend a higher fiber intake for people with

diabetes than for the population as a whole. American Diabetes Association notes that

recommendations for fiber intake for people with diabetes are similar to the

recommendations for the general public (14 g/1000 kcal), and that while diets containing

44 to 50 grams of fiber daily are reported to improve glycemia, more usual fiber intakes

(up to 24 grams daily) have not demonstrated beneficial effects on glycemia.. American


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Diabetes Association also notes that including foods containing 25 to 30 grams of fiber

per day, with special emphasis on soluble fiber sources (7 to 13 grams), can help to lower

cholesterol. They add that diets high in total and soluble fiber, as part of cardioprotective

nutrition therapy, can further reduce total cholesterol by 2% to 3% and LDL cholesterol

up to 7%.

Sucrose

The groups agree that sucrose does not need to be avoided by patients with diabetes

mellitus, but when consumed, should replace other carbohydrates. American Diabetes

Association notes that, in addition to being substituted for other carbohydrates, sucrose

may also be added to the meal plan, but if so, should be covered with insulin or other

glucose-lowering medications. . American Diabetes Association notes that sucrose

intakes of 10 to 35 percent of total energy intake do not have a negative effect on

glycemic or lipid responses when substituted for isocaloric amounts of starch.

Alcohol Consumption

According to American Diabetes Association, for adults with diabetes who choose to

consume alcohol, consumption should be limited to 1 drink per day for women and 2

drinks per day for men.. American Diabetes Association also notes that to reduce risk of

nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol

should be consumed with food. The developer adds that moderate alcohol consumption

(when ingested alone) has no acute effect on glucose and insulin concentrations, but

carbohydrate co-ingested with alcohol (as in a mixed drink) may raise blood glucose.


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Dietary Fat and Cholesterol

The guidelines agree that intake of trans fats should be minimized . American Diabetes

Association notes that n-3 polyunsaturated fatty acids have beneficial effects on the lipid

profile, and two or more servings of fish per week (with the exception of commercially

fried fish filets) provide n-3 polyunsaturated fatty acids and are recommended. .

American Diabetes Association cites reduction in saturated and trans fats, as well as

reduction of dietary cholesterol and interventions to improve blood pressure, as effective

cardioprotective nutrition interventions

.BENEFITS OF FRUITS AND VEGETABLES FOR DIABETIC PATIENT

According to the Food and Nutrition Institute, food composition table of 2004,

Fruits and vegetables are the very rich source of fiber. Although people may pay less

attention to fiber, its health benefits have not vanished. Fiber remains an essential nutrient

and a vital part of healthy eating for everyone, including those with diabetes. In fact,

soluble forms of plant fiber may help to mute blood sugar swings.

The New England Journal of Medicine 2011 showed that soluble fiber in oat bran,

legumes (dried beans of all kinds, peas and lentils), and pectin (from fruit, such as apples)

and forms in root vegetables (such as carrots) is considered especially helpful for people

with either form of diabetes. Soluble fiber may help control blood sugar by delaying

gastric (stomach) emptying, retarding the entry of glucose into the bloodstream and

lessening the postprandial (post-meal) rise in blood sugar. It may lessen insulin

requirements in those with type 1 diabetes. Because fiber slows the digestion of foods, it

can help blunt the sudden spikes in blood glucose that may occur after a low-fibre meal.


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Such blood sugar peaks stimulate the pancreas to pump out more insulin. National

Institute of health believe that a lifetime of blood glucose spikes could contribute to type

2 diabetes which typically strikes after the age of 40 and more than doubles the risk of

stroke and heart disease. .

Previous Researches of Diabetes in Nutrient Management

The evidence for the effectiveness of medical nutrition therapy in Diabetes

Mellitus to determine the clinical and cost- effectiveness Medical Nutrion Therapy as a

potential preventive benefit in the medi care program, the 105th

US congress, in the balanced budget act of 1997 requested that a study be conducted by the Institute of he

Medicine of The National Academy of Sciences.

In December 1999, Institute of Medicine release their report in reference to

diabetes the report concluded that evidences exist demonstrating that Medical Nutrition

Therapy can improve clinical outcome while possibly reducing the cost of managing

diabetes to medicare.

Institute of Medicine recommend to congress that individual Medical Nutrition

Therapy be a covered medicare benefits as part of multidisciplinary approach to diabetes

care which include nutrition, exercise, blood glucose monitoring, medication.

The evidenced from randomized controlled trials that involved 39,444 newly

diagnosed patient with type 2 Diabetes Mellitus at 15 centers. All received nutrition

counseling upon study entry until 3 months at which they were randomized into intensive

therapy resulted to an improvement of metabolic outcome such as fasting plasma glucose

was reduce 46mg/dl and Hba decreased by 1.9% from 9 to 7% average weight loose of


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CHAPTER III

METHODS OF THE RESEARCH

This chapter discusses the procedures to be done by the researchers to gather the

needed data. This includes the Research Design, Research locale, Participants, Sampling

Design and Data Gathering Procedure.

RESEARCH DESIGN

The study entitled Frutie -Vegs Diet for Blood Glucose Control among diabetic client

at WMSU is an experimental research that aims to determine the decrease in bloodglucose level of the Fruitie-Vegs intervention on the willing participants.

This is a quasi-experimental design employing the time-series method. This method

and design will select a group of diabetic client to participate in the experiment using

purposive-convenience sampling. This group of ten (10) diabetic clients will be

subjected to a glucose test for 5 consecutive days, one hour after lunch before the

intervention of the Frutie-Vegs diet. During the intervention for five consecutive days,

glucose test one-hour after lunch will also be taken. That would mean series of blood

glucose test will be done 5 days before and 5 days during the intervention.


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PARTICIPANTS/RESPONDENTS

The respondents of the study will be randomly chosen from the list of diabetic

clients taken from Barangay Tetuan. Only female client that were diagnosed with

diabetes will be chosen as participants.

Full consent of the client will be taken using a researchers constructed consent

for participation.

SAMPLING

Purposive and convenience is the method will be used in this study. Theresearchers will be using this method because the participants in this research study will

involve the female clients at Barangay Tetuan who is diagnosed with diabetes and that

researchers chose those who voluntarily and willingly consented to participate in the

experiment.

DATA GATHERING PROCEDURE

To gather the data needed for the research, the researcher will be using the

following instrument:

There will be a health teaching about the significance and implications of diet.

Procedure

Those diabetics who willingly signed for participation will be taken assubjects of the study.

Five days prior to the intervention of the FRUITY-VEG Diet post-prandial blood glucose test will be taken for five consecutive days among the study participants. Post-prandial would mean two hours after lunch, blood glucosetest will be done. Five days prior to the intervention the study participants


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will take his/her regular or usual breakfast, midday snack, lunch, afternoonsnacks, and dinner.

The five-day FRUITY-VEG alternative diet intervention will follow. Thatwould mean, on the next 5 days, the study participants will be served the

FRUITY-VEG alternative lunch. Two hours after the FRUITY-VEG lunch, blood glucose test will be taken. During the five days intervention, the study participants, will take their regular or usual breakfast, snacks, FRUITY-VEGalternative lunch, usual afternoon snack and dinner. Only the lunch is beingcontrolled which will be prepared and serve by the researcher.

The pre-intervention and post intervention blood glucose test results will becompared and determine the significant difference.

For those study participants who are under medical regimen, their medication will

continue as prescribed.

,INSTRUMENT OF THE STUDY

All data will be gathered and tabularized to organize the Pre-Intervention Blood

Glucose and Post Intervention Blood Glucose of the ten female participants of Barangay

Tetuan.

The statistics we will be using are the mean (X), standard deviation (SD), and the

T-test of difference. The t-test of difference is a statistics method use to compare one set

of measurements with a second set from the same sample. It is often used to compare

before and after scores in experiments to determine whether significan t change has

occurred. The T-test formula is:


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