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Langerman C, Forbes A, Robert G. Enhancing care in the initiation and management of insulin in older people with diabetes: A collaborative journey with older individuals and their caregivers using Experience-Based Co-Design. PLoS One 2024; 19:e0302516. [PMID: 39074147 DOI: 10.1371/journal.pone.0302516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/07/2024] [Indexed: 07/31/2024] Open
Abstract
INTRODUCTION Initiating insulin therapy in older individuals with type 2 diabetes (T2DM) poses unique challenges and requires a nuanced understanding of the age-related factors that impact safety and efficacy. This study employed Experience-Based Co-Design (EBCD) to enhance the insulin initiation and management experience for this population, emphasising a collaborative approach involving patients, caregivers, and healthcare professionals. AIM The primary aim of the research was to develop a tailored care pathway, utilising co-design and the Behaviour Change Wheel (BCW), which addressed issues specific to older adults on insulin therapy. The study sought to identify key challenges, propose practical interventions, and construct a logic model illustrating a pathway for enhanced insulin treatment experiences. METHODS An adapted EBCD process was used which integrated the Medical Research Council (MRC) Framework and BCW. The study involved thematic synthesis, video interviews, and feedback focus groups with patients, caregivers, and healthcare professionals. The 'Crazy Eights' brainstorming method, as part of the co-design workshop, generated practical solutions which informed subsequent logic model development. RESULTS Focus group findings revealed distressing insulin initiation experiences, inconsistent dietary advice, and perceived disparities in care between type 1 and type 2 diabetes. The co-design workshop identified eight key challenges, leading to proposed interventions aligned with the BCW. The logic model illustrates a pathway for older individuals undergoing insulin treatment, emphasising behaviour change among patients, caregivers, and healthcare professionals. CONCLUSION The collaborative efforts of participants contributed valuable insights in terms of the unique educational and emotional needs of patients, the importance of care continuity and of improving access to specialist services. Findings from this study can be used to inform and enhance tailored support strategies for older adults with T2DM during their insulin transition and ongoing management.
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Affiliation(s)
- Chaya Langerman
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Glenn Robert
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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Luciani M, Bigoni C, Canesi M, Masotto M, Fabrizi D, Di Mauro S, Ausili D. Self-Care of Adults with Type 2 Diabetes During the COVID-19 Pandemic: A Qualitative Interpretive Description Study. Clin Nurs Res 2023; 32:73-83. [PMID: 36196898 PMCID: PMC9535453 DOI: 10.1177/10547738221125991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Due to coronavirus disease 2019 (COVID-19), diabetes services have been disrupted, causing difficulties for people with type 2 diabetes mellitus (T2DM), and understanding their experience could help improve diabetes care. Therefore, we used a qualitative interpretive description to explore the experience of self-care of adults with T2DM during the COVID-19 pandemic. Data were collected using semi-structured interviews and analyzed theoretically. The sample (N = 30) was composed of 7 females and 23 males, with a mean age of 69.9 years (60-77) and 19.4 mean years (3-40) of people living with T2DM. Our findings show reduced physical activity and increased smoking and alcohol consumption affected that self-care. Increased food consumption and stress eating, with greater stress and anxiety, caused worsening of glycemic values. Participants were able to contact healthcare professionals via eHealth or telephone. Others, even those with complications, were not able to receive care or advice. These results suggest that easier contact with health providers, continuous engagement, eHealth solutions, and formal peer support could help self-care in T2DM. Advanced nursing roles and services could solve many issues reported in this study during and after the pandemic.
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Affiliation(s)
- Michela Luciani
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy,Luciani Michela, Department of Medicine and Surgery, University of Milano – Bicocca, Via Cadore 48, Monza 20900, Italy.
| | - Camilla Bigoni
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
| | - Marta Canesi
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
| | - Matteo Masotto
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
| | - Diletta Fabrizi
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
| | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
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Lee AYL, Wong AKC, Hung TTM, Yan J, Yang S. Nurse-led Telehealth Intervention for Rehabilitation (Telerehabilitation) Among Community-Dwelling Patients With Chronic Diseases: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40364. [PMID: 36322107 PMCID: PMC9669889 DOI: 10.2196/40364] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic diseases are putting huge pressure on health care systems. Nurses are widely recognized as one of the competent health care providers who offer comprehensive care to patients during rehabilitation after hospitalization. In recent years, telerehabilitation has opened a new pathway for nurses to manage chronic diseases at a distance; however, it remains unclear which chronic disease patients benefit the most from this innovative delivery mode. OBJECTIVE This study aims to summarize current components of community-based, nurse-led telerehabilitation programs using the chronic care model; evaluate the effectiveness of nurse-led telerehabilitation programs compared with traditional face-to-face rehabilitation programs; and compare the effects of telerehabilitation on patients with different chronic diseases. METHODS A systematic review and meta-analysis were performed using 6 databases for articles published from 2015 to 2021. Studies comparing the effectiveness of telehealth rehabilitation with face-to-face rehabilitation for people with hypertension, cardiac diseases, chronic respiratory diseases, diabetes, cancer, or stroke were included. Quality of life was the primary outcome. Secondary outcomes included physical indicators, self-care, psychological impacts, and health-resource use. The revised Cochrane risk of bias tool for randomized trials was employed to assess the methodological quality of the included studies. A meta-analysis was conducted using a random-effects model and illustrated with forest plots. RESULTS A total of 26 studies were included in the meta-analysis. Telephone follow-ups were the most commonly used telerehabilitation delivery approach. Chronic care model components, such as nurses-patient communication, self-management support, and regular follow-up, were involved in all telerehabilitation programs. Compared with traditional face-to-face rehabilitation groups, statistically significant improvements in quality of life (cardiac diseases: standard mean difference [SMD] 0.45; 95% CI 0.09 to 0.81; P=.01; heterogeneity: X21=1.9; I2=48%; P=.16; chronic respiratory diseases: SMD 0.18; 95% CI 0.05 to 0.31; P=.007; heterogeneity: X22=1.7; I2=0%; P=.43) and self-care (cardiac diseases: MD 5.49; 95% CI 2.95 to 8.03; P<.001; heterogeneity: X25=6.5; I2=23%; P=.26; diabetes: SMD 1.20; 95% CI 0.55 to 1.84; P<.001; heterogeneity: X24=46.3; I2=91%; P<.001) were observed in the groups that used telerehabilitation. For patients with any of the 6 targeted chronic diseases, those with hypertension and diabetes experienced significant improvements in their blood pressure (systolic blood pressure: MD 10.48; 95% CI 2.68 to 18.28; P=.008; heterogeneity: X21=2.2; I2=54%; P=0.14; diastolic blood pressure: MD 1.52; 95% CI -10.08 to 13.11, P=.80; heterogeneity: X21=11.5; I2=91%; P<.001), and hemoglobin A1c (MD 0.19; 95% CI -0.19 to 0.57 P=.32; heterogeneity: X24=12.4; I2=68%; P=.01) levels. Despite these positive findings, telerehabilitation was found to have no statistically significant effect on improving patients' anxiety level, depression level, or hospital admission rate. CONCLUSIONS This review showed that telerehabilitation programs could be beneficial to patients with chronic disease in the community. However, better designed nurse-led telerehabilitation programs are needed, such as those involving the transfer of nurse-patient clinical data. The heterogeneity between studies was moderate to high. Future research could integrate the chronic care model with telerehabilitation to maximize its benefits for community-dwelling patients with chronic diseases. TRIAL REGISTRATION International Prospective Register of Systematic Reviews CRD42022324676; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=324676.
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Affiliation(s)
- Athena Yin Lam Lee
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | | | - Tommy Tsz Man Hung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jing Yan
- Zhejiang Hospital, Zhejiang, China
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Li J, Yang F, Wang J, Tao Y. Effect of community-based nurse-led support intervention in the reduction of HbA1c levels. Public Health Nurs 2022; 39:1318-1333. [PMID: 36029098 DOI: 10.1111/phn.13119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the effect of community based Nurse-led support intervention in the reduction of HbA1c levels compared to usual care. DESIGN AND METHODS A systematic search of four electronic databases was conducted until August 2021 including RCTs to check for a reduction in HbA1c levels in Nurse-led intervention arm. RESULTS Twenty-one trials involving 4649 diabetic individuals were included in the review. The pooled mean difference in the reduction of HbA1c in the intervention group was found to be -0.421 (95% CI: -0.59 to -0.25). CONCLUSION AND EVIDENCE Nurse-led educational intervention proved beneficial in the control of HbA1c among diabetic individuals.
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Affiliation(s)
- Juan Li
- Department of Nursing, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Fang Yang
- Department of Nursing, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jie Wang
- Department of Neurology, Hubei University of Medicine, China
| | - Yanli Tao
- Department of Neurology, Hubei University of Medicine, China
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Kuguyo O, Chirenda J, Chikwasha V, Mukona DM, Mageza A, Gwanzura L, Matimba A. Needs assessment of diabetic foot services in Zimbabwe. Diabetes Res Clin Pract 2022; 188:109925. [PMID: 35577036 DOI: 10.1016/j.diabres.2022.109925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Due to the increasing incidence of diabetes in Zimbabwe, complications such as diabetic foot (DF) are anticipated. Establishing local gaps and needs in DF healthcare is paramount for tailoring management strategies. AIMS To determine the status of DF services in the healthcare system and explore awareness of DF management and practices among registered general nurses (RGNs) in Zimbabwe. METHODS A mixed-methods approach was applied. Thirty-one RGNs from 16 public health facilities in Harare, Zimbabwe attending a DF workshop were administered with a cross-sectional survey instrument and a semi-structured questionnaire. Data collected included presence/absence of DF services and podiatrists in healthcare facilities, healthcare system approaches in DF care and availability of DF training/education programs for RGNs. Analysis was performed using Stata and Nvivo software. RESULTS No respondents reported availability of podiatrists. Only 1 (3%) of RGNs reported DF screening in primary care. Sixty percent (18) did not know or had never screened for DF. The RGNs reported inadequate DF educational programs/modules in primary care settings. CONCLUSION This data highlights a need to improve DF education for RGNs at the frontline of managing PLWD. Understanding the needs for DF services may guide interventions to improve education and awareness programs that are appropriately tailored to local constraints in the health system. The non-communicable diseases director is encouraged to develop DF educational programmes for frontline health care workers.
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Affiliation(s)
- Oppah Kuguyo
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe.
| | - Joconiah Chirenda
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe.
| | - Vasco Chikwasha
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe.
| | - Doreen Macherera Mukona
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe; Parirenyatwa Group of Hospitals, Department of Surgery, Parirenyatwa Complex, Mazowe Street, Harare, Zimbabwe.
| | - Akimu Mageza
- Parirenyatwa Group of Hospitals, Department of Surgery, Parirenyatwa Complex, Mazowe Street, Harare, Zimbabwe.
| | - Lovemore Gwanzura
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe.
| | - Alice Matimba
- University of Zimbabwe, Faculty of Medicine and Health Sciences, P.O. Box A178, Avondvale, Harare, Zimbabwe.
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Self-Management Nursing Intervention for Controlling Glucose among Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312750. [PMID: 34886488 PMCID: PMC8657503 DOI: 10.3390/ijerph182312750] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 01/14/2023]
Abstract
As the diabetic population increases, self-management of diabetes, a chronic disease, is important. Given that self-management nursing interventions using various techniques have been developed, an analysis of their importance is crucial. This study aimed to identify the overall effects of self-management nursing interventions on primary (HbA1c) and secondary (self-care, self-efficacy, fasting blood sugar level blood pressure, lipid, body mass index, waist circumference, distress, anxiety, depression, and quality of life) outcomes in diabetes. Systematic review and meta-analysis were used. The meta-analysis involved the synthesis of effect size; tests of homogeneity and heterogeneity; trim and fill plot; Egger’s regression test; and Begg’s test for assessing publication bias. The overall effect on HbA1c was −0.55, suggesting a moderate effect size, with HbA1c decreasing significantly after nursing interventions. Among the nursing interventions, the overall effect on HbA1c of nurse management programs, home visiting, and customized programs was −0.25, −0.61, and −0.65, respectively, a small or medium effect size, and was statistically significant. Healthcare professionals may encourage people with diabetes to engage in self-management of their glucose levels, such as patient-centered customized intervention. Interventions that reflect the individual’s characteristics and circumstances are effective in enabling self-management.
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Sharma SK, Thakur K, Kant R, Mudgal SK. Impact of Nurse-Led Titration Versus Physician Prescription of Hypoglycaemic Agents on HbA1c Level in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2021; 13:e20436. [PMID: 35047273 PMCID: PMC8759459 DOI: 10.7759/cureus.20436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/18/2022] Open
Abstract
A nurse-led diabetic clinic to manage type 2 diabetes, which emphasizes medication adherence, titration of hypoglycemic agents, behavior modification, and motivation for lifestyle changes, is widely recommended and practiced in western countries. This review aims to examine the impact of a nurse-led diabetic clinic versus a standard physician-led diabetic clinic on glycaemic control of type 2 diabetes patients. Studies were obtained using a comprehensive search in the electronic databases of PubMed, Embase, SCOPUS, Cochrane Library, and gray literature through March 2021. We calculated the pooled effect estimate with 95% confidence intervals (CIs) comparing subjects with and without nurse-led titration of hypoglycemic agents using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes. Four trials comprising 470 participants (241 intervention group and 229 control group) met the inclusion criteria. Glycated hemoglobin (HbA1c levels and BMI were lower in participants with a nurse-led diabetic clinic (SMD = -0.54, 95% CI -0.89 to -0.20, I2 = 67%, p = 0.002) and (SMD = -0.26 (95% CI -0.45 to -0.07, I2 = 0%, p = .008), respectively, than in those attending a standard physician-led diabetic clinic. Similarly, the pooled result shown that patients attending the nurse-led diabetic clinic had a 31% higher satisfaction level (RR 0.69; 95% CI, 0.51 to 0.92, I2 = 0%, p= 0.01). On the other hand, there was no significant association of the nurse-led diabetic clinics on patients' blood pressure and intensification of hypoglycemic agents. The certainty of the evidence assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was moderate for outcomes like HbA1c level, intensification of hypoglycemic agents, and patients' satisfaction and low for other secondary outcomes. Our meta-analysis allows for the conclusion that nurse-led titration of hypoglycemic agents is associated with better glycemic control and enhances patients' satisfaction. Therefore, it is recommended to establish and strengthen nurses-led diabetic clinics for better HbA1c control where physician-led diabetic services are limited. Further research is needed to enhance the quality of the evidence.
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Affiliation(s)
- Suresh K Sharma
- Medical and Surgical Department, All India Institute of Medical Sciences, Jodhpur, IND
| | - Kalpana Thakur
- Psychiatry and Mental Health Department, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ravi Kant
- Diabetes and Metabolism Division, All India Institute of Medical Sciences, Rishikesh, IND
| | - Shiv K Mudgal
- Medical and Surgical Department, All India Institute of Medical Sciences, Deoghar, IND
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An L, Wang Y, Cao C, Chen T, Zhang Y, Chen L, Ren S, Tang M, Ma F, Li X, Yuan S, Zhao W, Lee Y, Xiao J. Screening cardiovascular risk factors of diabetes patients in the primary diabetes clinics. Medicine (Baltimore) 2021; 100:e26722. [PMID: 34397707 PMCID: PMC8322505 DOI: 10.1097/md.0000000000026722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/05/2021] [Accepted: 07/04/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT To evaluate the atherosclerotic cardiovascular diseases (ASCVD) risk factors in type 2 diabetes patients from the primary diabetes clinics for further comprehensive intervention in China.A cross-sectional study was conducted in 5 primary diabetes chain hospitals in Beijing, Lanzhou, Harbin, Chengdu, and Taiyuan in continuous patients with type 2 diabetes from March 2016 to December 2019. The data collected at the first visit were analyzed, and proportions of patients reached the targets (glycosylated hemoglobin [HbA1c] < 7%, blood pressure < 130/80 mm Hg, and low-density lipoprotein cholesterol [LDL-C] < 2.6mmol/l) were calculated. The clinical characteristics and the associated factors with achievement in HbA1c, blood pressure, and LDL-C targets were analyzed.A total of 20,412 participants, including 11,353 men (55.6%), with an average age of (59.4 ± 10.4) years were enrolled. Nearly 95% diabetes had one or more ASCVD risk factors other than hyperglycemia. The control rates of HbA1c, blood pressure, and LDL-C were 26.5%, 27.8%, and 42.6%, respectively. Only 4.1% patients achieved all 3 targets. Nearly 95% patients had one or more ASCVD risk factors other than hyperglyciemia. Diabetes duration, family history, and overweight/obesity were associated with the number of aggregated ASCVD risk factors. The patients with older age, no overweight/obesity, not smoking, less ASCVD risk factors, and having special diabetes care insurance (Chengdu) were associated with a higher control rates.To deal with poor control status, global management of ASCVD risk factors, weight loss, and smoking cessation must be emphasized in the primary diabetes care settings. Special diabetes care insurance should be advocated.Current ClinicalTrial.gov protocol ID NCT03707379. Date of Registration: October 16, 2018. https://clinicaltrials.gov.
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Affiliation(s)
| | - Yanlei Wang
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Chenxiang Cao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Tao Chen
- Chengdu Ryan Diabetes Hospital, Chengdu
| | | | | | | | | | | | | | - Shuang Yuan
- Heilongjiang Ruijing Diabetes Hospital, Harbin, Heilongjiang, China
| | - Wenhui Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Yaujiunn Lee
- Lee's Clinic, No. 130, Min-Zu Rd, Pingtung, Taiwan
| | - Jianzhong Xiao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
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Bulucu-Büyüksoy GD, Karataş N. The Effect of Care Provided at Home by Public Health Nurse on Control of Type II Diabetes Mellitus. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2020; 28:287-298. [PMID: 34263208 PMCID: PMC8134012 DOI: 10.5152/fnjn.2020.19092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 12/12/2019] [Indexed: 12/04/2022]
Abstract
AIM The aim of the study was to examine the effect of home care provided for patients with type II diabetes by public health nurse on HbA1c, and to investigate the opinions of these patients regarding diabetes. METHOD The quantitative aspect of the study consisted of a pre and posttest with the control group; the qualitative aspect consisted of a semi-structured interviewing technique. The sample size was 48 patients receiving treatment within the clinic of hospital during 11th-30th April 2016. Because some patients were excluded from the study, the research was completed with a sample size of 20 for the experiment and 20 for the control group. The following forms were used during data: Pre and post measurement and qualitative interview forms. A total of seven home visits were conducted for the experiment group and two home visits for the control group, during 2nd May to 27th October, 2016. RESULTS HbA1c decreased by 0.75% in the experiment group (p<0.05). It was found that faulty usage of insulin was treated; all patients developed the habit of tracking blood glucose. Blood glucose of three patients continued to remain at high levels, and most of the patients failed to develop healthy eating habits and regular exercising. CONCLUSION According to these results, it is advised that long-term interventions be planned with the contributions of other experts.
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Affiliation(s)
| | - Nimet Karataş
- Department of Public Health Nursing, Retired Faculty Member, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
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Xu D(R, Dev R, Shrestha A, Zhang L, Shrestha A, Shakya P, Hughes JP, Shakya PR, Li J, Liao J, Karmacharya BM. NUrse-led COntinuum of care for people with Diabetes and prediabetes (NUCOD) in Nepal: study protocol for a cluster randomized controlled trial. Trials 2020; 21:442. [PMID: 32471476 PMCID: PMC7257188 DOI: 10.1186/s13063-020-04372-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing a standard diabetes program in Nepal. METHODS We will conduct a two-arm, parallel group, stratified cluster randomized controlled trial of the NUrse-led COntinuum of care for people with Diabetes (N1 = 200) and prediabetes (N2 = 1036) (NUCOD) program, with primary care centers (9 outreach centers and 17 government health posts) as a unit of randomization. The NUCOD program will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared with the usual treatment group at 6 and 12 months of the intervention. The primary outcome will be the change in glycated hemoglobin (HbA1c) level among diabetes individuals and progression to type 2 diabetes among prediabetes individuals, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. Outcomes will be analyzed on an intention-to-treat basis. DISCUSSION The results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. The continuum of care model can be used for the prevention and management of diabetes and other noncommunicable diseases within and beyond Nepal with similar context. TRIAL REGISTRATION ClinicalTrials.gov, NCT04131257. Registered on 18 October 2019.
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Affiliation(s)
- Dong ( Roman) Xu
- Sun Yat-sen University Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, China
| | - Rubee Dev
- Sun Yat-sen University Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, China
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Lingling Zhang
- College of Nursing and Health Sciences, University of Massachusetts, Boston, MA USA
| | - Archana Shrestha
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA USA
| | - Pushpanjali Shakya
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA USA
| | - Prabin Raj Shakya
- College of Dentistry, Biomedical Knowledge Engineer Lab, Seoul National University, Seoul, Korea
| | - Jinghua Li
- Sun Yat-sen University Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, China
| | - Jing Liao
- Sun Yat-sen University Global Health Institute (SGHI), Sun Yat-sen University, Guangzhou, China
| | - Biraj Man Karmacharya
- Department of Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Kavre, Nepal
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