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The latest evidence for practice

Choice picks from the research journals, with some choice comment …

Una Adderley
Community Tissue
Viability Prescribing
Nurse

Do lifestyle or pharmacological interventions prevent or delay type 2 diabetes in people with impaired glucose tolerance?

Patients who develop type 2 diabetes will have had a period of impaired glucose intolerance prior to diabetes being diagnosed. Type 2 diabetes treatment is based on encouraging the patient to make changes to their lifestyle and may include medication.
This systematic review examined the results of 17 randomised controlled trials that had evaluated an intervention to delay or prevent type 2 diabetes in people with impaired glucose tolerance. The review found that lifestyle interventions, which included diet, exercise or both, and pharmacological interventions, which included oral diabetes drugs or an antiobesity drug, reduced the incidence of type 2 diabetes. The review concluded that lifestyle or pharmacological interventions could prevent or delay type 2 diabetes in people with impaired glucose tolerance.
A commentary notes that individualised, tailored, long-term interactions with a facilitator can help patients change towards more healthy lifestyles. Furthermore, patients are more likely to adhere to recommended medication regimens if they have frequent communication with nurses who understand the strengths and weaknesses of the patient's social context. However, there will be costs associated with such interventions; these need evaluation.

Reference
Gillies CL, Abrams KR, Lambert PC, et al. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta-analysis. BMJ 2007;334:299.

Commentary
Upchurh SL. Evid Based Nurs 2007;10:78.

Is duct tape effective for treatment of common warts (verrucae vulgaris) in adults?
Viral warts are a common affliction. They are slow to heal and can make patients feel very self-conscious; many folk remedies exist. A Cochrane review found that topical treatments containing salicylic acid have a therapeutic effect, but the authors noted that more research was needed to determine the effectiveness of other treatments.
This USA randomised controlled trial examined the effectiveness of duct tape in 90 adults with warts. Forty-four patients had duct tape applied to the adhesive side of moleskin pads and 46 patients had moleskin pads only. The wart was pared with a scalpel blade and patients were instructed to wear a single pad for seven days, remove the pad on the evening of the seventh day and leave uncovered overnight. On day eight, patients were asked to soak and lightly debride the wart with a coarse grit emery board and apply a new pad. The cycle was repeated for two months.
At two months, there was no difference in the number of warts healed between the two groups and the authors concluded that duct tape was not an effective treatment for warts.
A commentator notes that the trial used transparent acrylic-based duct tape rather than silver, rubber-based duct tape, which may be more effective. However, when advising patients, clinicians should note that although large pieces of silver, rubber-based duct tape have not yet been evaluated in a randomised trial, salicylic acid is known to be effective and 65% of warts in children resolve within two years.

Reference
Wenner R, Askari SK, Cham PM, et al. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Arch Dermatol 2007;143:309-13.

Commentary
Lamarche K. Evid Based Nurs 2007;10:108.