FACTORS INFLUENCING INSULIN BIOCHEMISTRY IN UK DIABETIC PATIENTS: SYSTEMATIC REVIEW

Manuchimso Charles Akaninwor 102 PAGES (29520 WORDS) Dissertation
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ABSTRACT

BACKGROUND: Diabetes Mellitus has proved to become a global public health issue, given the growing burden of the disease (prevalence) and associated metabolic diseases. Empirical evidence from clinical studies demonstrates the influence of insulin biochemistry (parameters) – insulin resistance, insulin secretion and insulin sensitivity – in the development of Diabetes Mellitus; however, the factors underlying the biochemical behaviour these insulin parameters and their associated impact level are note worthy. Therefore, the aim of this systematic review is to assess the factors influencing Insulin Biochemistry in UK diabetic patients (diagnosed and undiagnosed).

METHOD: This systematic review identified primary research articles associated with the factors influencing insulin biochemistry (parameters), published in the UK over the last 20 years (between 1993 and 2013). Database-searched articles (using Advanced search with Boolean operators and the key search terms) and manually-searched articles (Using Basic search and the key search terms) that passed the predetermined inclusion/exclusion criteria were selected, critically appraised (using a CASP checklist), and the data analysed and synthesised using a narrative evidence synthesis. The search databases include: EBSCOhost (Discover), Pubmed (Medline), Medline with full text and CINAHL Plus with full text; Microsoft office Excel application was used as the data extraction matrix for individual studies included.

FINDINGS: 1074 articles were identified for Title/Abstract and Full text screening, with 14 articles included for analysis, after the inclusion/exclusion criteria-based screening process. 11 of the studies focused on insulin resistance; while, the other 3 studies, focused on insulin sensitivity and insulin secretion. Physical, Dietary, Biochemical, Genetic, and Morbidity factors were significantly associated and correlated with insulin resistance; while, Exercise/Fitness and Medication/Supplementation factors were associated with insulin sensitivity and insulin secretion, across different population groups in UK.

CONCLUSION: Insulin parameters are influenced by both intrinsic and extrinsic biological factors; with the most predominant influence exerted by Biochemical, Genetic and Medication (Supplementation) factors. The impact of these influences, results in the development of Diabetes mellitus, Insulin resistance syndrome, Beta-cell dysfunction and other related metabolic diseases.


TABLE OF CONTENTS

DECLARATION 2

DEDICATION 3

ACKNOWLEDGEMENTS 4

ABSTRACT 8

KEY WORDS 9

ABBREVIATIONS 9

1.0 CHAPTER ONE 10

1.1 INTRODUCTION 10

1.2 BACKGROUND 11

1.2.1 Types of Diabetes Mellitus 11

1.2.2 Risks Factors of Diabetes Mellitus 13

1.2.3 Statistical Variations of Diabetes Mellitus 13

1.3 STUDY RATIONALE 14

1.4 RESEARCH (REVIEW) QUESTION 16

1.5 AIM AND OBJECTIVES 16

2.0 CHAPTER TWO – LITERATURE REVIEW 17

2.1 INTRODUCTION 17

2.1.1 Inclusion Criteria 17

2.1.2 Exclusion Criteria 17

2.2 REVIEW OF LITERATURE 18

2.3 INSULIN RESISTANCE 18

2.3.1 Influence of Biochemical Components 18

2.3.2 Influence of Medication (Supplementation) 20

2.3.3 Influence of Psychological Factors 21

2.3.4 Ethnic Variations and Insulin Resistance 21

2.3.5 Influence of Dietary Factors 21

2.3.6 Physical factors/Fitness and Insulin Resistance 22

2.4 INSULIN SECRETION 22

2.4.1 Influence of Biochemical Components 22

2.4.2 Influence of Medication (Supplementation) 24

2.4.3 Physical Factors/Fitness and Insulin Resistance 25

2.5 INSULIN SENSITIVITY 25

2.5.1 Influence of Biochemical Components 26

2.5.2 Influence of Dietary factors 27

2.5.3 Influence of Medication (Supplementation) 28

2.5.4 Influence of Physical Activities, Morbidity and Ethnicity 29

2.6 CHAPTER SUMMARY 30

CHAPTER THREE – METHODOLOGY 32

3.1 INTRODUCTION 32

3.2 BACKGROUND 32

3.3 SYSTEMATIC REVIEW METHODOLOGY 33

3.3.1 Methodological Protocol 34

3.4 RESEARCH (REVIEW) QUESTION AND INCLUSION/EXCLUSION CRITERIA 35

3.4.1 Inclusion/Exclusion Criteria and Rationale 35

3.5 SEARCH STRATEGY FOR IDENTIFYING LITERATURE 36

3.5.1 Search Terms and Boolean Operators 37

3.5.2 Strategy for Screening Studies 37

3.5.3 Framework of Selection 37

3.5.4 Study Outcome Measures 39

3.5.5 Flow Chart of Searches and Screening 40

3.6 DATA EXTRACTION 41

3.7 QUALITY APPRAISAL 41

3.8 ANALYSIS OF DATA 42

3.9 DATA PROTECTION AND SAFE KEEPING 43

3.10 THE REVIEW (RESEARCH) ETHICAL CONSIDERATIONS 43

3.11 RESEARCH TIMELINE AND BUDGET 44

3.12 CHAPTER SUMMARY 44

CHAPTER FOUR – RESULTS 47

4.1 INTRODUCTION 47

4.2 FACTORS INFLUENCING INSULIN RESISTANCE 47

4.2.1 Physical Factors 47

4.2.2 Dietary Factor 49

4.2.3 Biochemical Factors 49

4.2.4 Genetic Factors 50

4.2.5 Morbidity Factor 51

4.3 FACTORS INFLUENCING INSULIN SENSITIVITY AND INSULIN SECRETION 52

4.3.1 Exercise (Fitness) Factor 52

4.3.2 Medication (Supplementation) Factors 52

4.4 CHAPTER SUMMARY 53

CHAPTER FIVE – DISCUSSION 62

5.1 INTRODUCTION 62

5.2 DISCUSSION OF FINDINGS 62

5.2.1 Factors Influencing Insulin Resistance 62

5.2.2 Factors Influencing Insulin Sensitivity and Insulin Secretion 64

5.2.3 Author’s Conclusion 65

5.3 IMPLICATIONS OF FINDINGS 67

5.4 LIMITATIONS OF REVIEW 69

5.4.1 Strengths and Weaknesses of Included Studies 69

5.4.2 Strengths and Weaknesses of Review 69

5.5 DISSEMINATION 70

5.6 FUTURE RESEARCH 71

5.7 CHAPTER SUMMARY 72

6.0 CONCLUSION 74

6.1 REFLECTION ON LEARNING 79

7.0 REFERENCES 80

8.0 BIBLIOGRAPHY 97

9.0 APPENDICES 98

9.1 APPENDIX 1 – DATA EXTRACTION MATRIX (MICROSOFT EXCEL SPREADSHEET) 98

9.2 APPENDIX 2 – CASP APPRAISAL TOOL 98

9.3 APPENDIX 3 – DISSERTATION TIMELINE 100

9.4 APPENDIX 4 – ETHICAL APPROVAL LETTER 102


FIGURES

Figure 1 – Flow-chart for Searches 40


TABLES

Table 1 – Grading Profile of Quality Appraisal 42

Table 2 – Synopsis of Selected Studies 55

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APA

Manuchimso Charles, A (2019). FACTORS INFLUENCING INSULIN BIOCHEMISTRY IN UK DIABETIC PATIENTS: SYSTEMATIC REVIEW. Afribary.com: Retrieved July 24, 2019, from https://afribary.com/works/masters-dissertation-1206817

MLA 8th

Akaninwor, Manuchimso Charles. "FACTORS INFLUENCING INSULIN BIOCHEMISTRY IN UK DIABETIC PATIENTS: SYSTEMATIC REVIEW" Afribary.com. Afribary.com, 24 Jun. 2019, https://afribary.com/works/masters-dissertation-1206817 . Accessed 24 Jul. 2019.

MLA7

Akaninwor, Manuchimso Charles. "FACTORS INFLUENCING INSULIN BIOCHEMISTRY IN UK DIABETIC PATIENTS: SYSTEMATIC REVIEW". Afribary.com, Afribary.com, 24 Jun. 2019. Web. 24 Jul. 2019. < https://afribary.com/works/masters-dissertation-1206817 >.

Chicago

Akaninwor, Manuchimso Charles. "FACTORS INFLUENCING INSULIN BIOCHEMISTRY IN UK DIABETIC PATIENTS: SYSTEMATIC REVIEW" Afribary.com (2019). Accessed July 24, 2019. https://afribary.com/works/masters-dissertation-1206817