The effectiveness of a diabetes nurse clinic in treating older patients with type 2 diabetes for their glycaemic control

Self-Management Nursing Intervention for Controlling Glucose among Diabetes: A Systematic Review and Meta-Analysis

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.

The effect of education given to type 2 diabetic individuals on diabetes self-management and self-efficacy: Randomized controlled trial

AIM

This study used a randomized controlled trial design and was carried out to examine the effect of education on diabetes self-management and self-efficacy in patients with type 2 diabetes.

METHODS

The study was carried out between July 2016-March 2017. Data were collected using information form, Diabetes Self-Management Questionnaire (DSMQ), self-efficacy scale for patients with type 2 diabetes (DSS).The individuals in the experimental group were given education. Both groups were reminded about the control time of their metabolic values on the phone in the 3rd and 6th months.

RESULTS

The average age of the individuals was 59.91 ± 8.93 (n = 78), 62.8% (n = 49) were female, 92.3% (n = 72), were married, 42.3% (n = 33) were high school graduates and their diabetes duration was 7.05 ± 3.9. There was a statistically significant difference in the 6th month metabolic values in the experimental group compared to the control group. When diabetes self-management and self-efficacy were examined, a statistically significant difference was found in the experimental group compared to the control group at 3rd and 6th months (p < 0.05, p < 0.01).

CONCLUSION

In this study, a significant increase in diabetes self-management and self-efficacy and a significant decrease in metabolic values were observed as a result of education and phone reminders given to individuals with type 2 diabetes.

The clinical effectiveness of nursing models of diabetes care: A synthesis of the evidence

OBJECTIVES

To determine the clinical effectiveness (glycemic control, other biological measures, cost-effectiveness and patient satisfaction) of primary care nurse-led interventions for diabetes.

DESIGN

A systematic review following methods described for complex interventions and using PRISMA guidelines for reporting was undertaken. Nurse-led care for diabetes can be regarded as a complex intervention requiring the measurement of more than one outcome and for this reason we chose a range of outcomes clinical (symptoms), patient-centred (experiences) and organisational (cost-effectiveness).

DATA SOURCES

An extensive literature search using MEDLINE (PubMed) EMBASE, and CINAHL was conducted.

REVIEW METHODS

Primary studies with adults in primary care with both quantitative (comparison with physician-led care and cost-effectiveness) and qualitative (patient experiences of nurse-led care) methodologies from 2003 until June 2018. All studies were appraised using the Cochrane Collaboration's tool for assessing risk of bias. The appraisal involved evaluation of the degree of risk of bias in selection, performance, detection, attrition and reporting. Because of the complexity of multiple outcomes (quantitative and qualitative) a narrative synthesis was undertaken.

RESULTS

The search generated 18 published studies that met our eligibility criteria. Three randomized controlled trials and one historical control trial found statistically significant differences in glycemic levels in favour of the nurse-led interventions. Two cluster randomized trials, two randomized pragmatic trials and two randomized controlled trials found no differences between groups. The three open-label studies found statistically significant improvements in HbA1c levels. The audit identified that more patients had lower HbA1c levels after the initiation of a nurse-led intervention. Three randomized controlled trials found significant improvements in biological outcomes and one did not. The four studies measuring cost-effectiveness found the nurse-led intervention was associated with less costs. Four studies examined patient satisfaction with nurse-led care and found this was very good.

CONCLUSION

This review which incorporated a broad range of studies to capture the complexity of nurse-led interventions has identified that there is evolving evidence that nurse-led interventions for community treatment of diabetes may be more clinically effective than usual physician-led care.

Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial

The aim of the study was to examine the effects of a brief stage-matched smoking cessation intervention group compared with a control group (with usual care) in type 2 diabetes mellitus patients who smoked by randomized controlled trial. There were 557 patients, randomized either into the intervention group (n = 283) who received brief (20- minute) individualized face-to-face counseling by trained nurses and a diabetes mellitus-specific leaflet, or a control group (n = 274) who received standard care. Patient follow-ups were at 1 week, 1 month, 3 months, 6 months, and 12 months via telephone, and assessment of smoking status from 2012 to 2014. Patients smoked an average of 14 cigarettes per day for more than 37 years, and more than 70% were in the precontemplation stage of quitting. The primary outcome showed that both the intervention and control groups had similar 7-day point-prevalence smoking abstinence (9.2% vs. 13.9%; p = 0.08). The secondary outcome showed that HbA1c levels with 7.95% [63 mmol/mol] vs. 8.05% [64 mmol/mol], p = 0.49 at 12 months, respectively. There was no evidence for effectiveness in promoting the brief stage-matched smoking cessation or improving glycemic control in smokers with type 2 diabetes mellitus, particularly those in the pre-contemplation stage.

Evidence based review of type 2 diabetes prevention and management in low and middle income countries

AIM: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context.

METHODS: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes.

RESULTS: A total of 66 studies from 20 developing countries were gathered with publication dates through September 2014. India contributed the largest number of trials (11/66). Of the total 66 studies reviewed, all but 3 studies reported evidence of favorable outcomes in the prevention and control of type 2 diabetes. The overwhelming majority of studies reported on diabetes management (56/66), and among these more than half were structured lifestyle education programs. The evidence suggests that lifestyle education led by allied health professionals (nurses, pharmacists) were as effective as those led by physicians or a team of clinicians. The remaining diabetes management interventions focused on diet or exercise, but the evidence to recommend one approach over another was weak.

CONCLUSION: Large experimental diabetes prevention/control studies of dietary and exercise interventions are lacking particularly those that consider quality rather than quantity of carbohydrates and alternative exercise.

A cross-sectional survey of self-perceived health status and metabolic control values in patients with type 2 diabetes

BACKGROUND

The prevalence of diabetes is increasing worldwide. Diabetes and other chronic disorders play an important role in how patients perceive their health status, this perception being an important component of general health.

OBJECTIVES

The purpose of this study is to determine self-perceived health status and metabolic control in patients with type 2 diabetes and to understand the relationship between perceived health status and metabolic control in diabetic participants.

DESIGN

This is a cross-sectional survey.

SETTING

The research population was diabetes sufferers registered with the Turkish Diabetes Society in Denizli Province, Turkey.

PARTICIPANTS

A convenience sample composed of 110 patients with type 2 diabetes mellitus.

METHODS

The research data were collected using three tools. The first of these was a "Socio-demographic Data Form" to gather information on the diabetes patients. The second was a survey on the patients' self-perceived health (how do rate your state of health in general) in which the patients were asked to rate their own health in one of five categories: very good, good, fair, bad and very bad. For the statistical analysis, the study group was divided into two groups: "good", consisting of those who classified their health as either very good or good; and "poor", those who gave other responses. The third type of data was collected by measuring metabolic control outcomes [glycosylated hemoglobin (HbA(1C)), fasting blood sugar (FBS), non-fasting blood sugar, total cholesterol, high-density lipoproteins (HDL) and triglycerides] for each participant.

RESULTS

Approximately half of the diabetic participants surveyed have poor self-perceived health. In terms of the values of HbA(1C), an important indicator of metabolic control levels, it was found that only 24.5% of the participants surveyed had good metabolic control. There was found to be a statistically significant difference between self-perceived health and levels of HbA(1C); 68% of participants who had high HbA(1C) values evaluated their health as good, whereas 63.9% of those who had poor HbA(1C) values evaluated their health as bad. Age, level of education, mode of treatment, adherence to treatment and level of exercise were factors that were found to have statistically significant differences from, and therefore an influence on, self-reported health.

CONCLUSION

When working with diabetes patients, as soon as the diagnosis has been made, it is recommended that information both on subjective perceptions of health and on perceptions of the illness (health perceptions, health beliefs related to the illness) are evaluated and objective data (metabolic control values) are gathered.

Nurse practitioner-led multidisciplinary teams to improve chronic illness care: the unique strengths of nurse practitioners applied to shared medical appointments/group visits

PURPOSE

To describe the roles of nurse practitioners (NPs) in a novel model of healthcare delivery for patients with chronic disease: shared medical appointments (SMAs)/group visits based on the chronic care model (CCM). To map the specific skills of NPs to the six elements of the CCM: self-management, decision support, delivery system design, clinical information systems, community resources, and organizational support.

DATA SOURCES

Case studies of three disease-specific multidisciplinary SMAs (diabetes, heart failure, and hypertension) in which NPs played a leadership role.

CONCLUSIONS

NPs have multiple roles in development, implementation, and sustainability of SMAs as quality improvement interventions. Although the specific skills of NPs map out all six elements of the CCM, in our context, they had the greatest role in self-management, decision support, and delivery system design.

IMPLICATIONS FOR PRACTICE

With the increasing numbers of patients with chronic illnesses, healthcare systems are increasingly challenged to provide necessary care and empower patients to participate in that care. NPs can play a key role in helping to meet these challenges.

A review of the activity and effects of nurse-led care in diabetes

AIMS AND OBJECTIVES

To identify systematically, summarize and critically appraise the current evidence regarding the activity and effects of nurse-led care in diabetes.

BACKGROUND

A diverse range of nurse-led models of care exist in diabetes. Primary studies have been conducted evaluating these models, but review and synthesis of the findings from these studies has not been undertaken.

METHOD

Systematic searches of CINAHL, MEDLINE and British Nursing Index from 1996 until June 2006. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles.

RESULTS

Twenty-two relevant publications were identified and included findings from both primary and secondary care. The evidence indicates that nurses are involved in specific areas of care including education, individualized care, patient safety, promotion of self-care, acquisition of physical skills and psychological support. Improved glycemic control, diabetic symptoms, cost-effectiveness and decreased length of hospital stay are the main benefits of nurse-led interventions in diabetes care. Disease management protocols are the main mechanism by which nurses adjust and titrate medicines for patients with diabetes. Patient evaluations of nurse-led care report improved self-care and patient knowledge.

CONCLUSIONS

Findings of the review are generally positive. However, there are methodological weaknesses and under researched issues e.g. poor descriptions of the nurse interventions, the educational needs of nurses and the prescription of medicines by nurses for patients with diabetes, that point to a need for further rigorous evaluation.

RELEVANCE TO CLINICAL PRACTICE

Nurse-led care is an integral element of the diabetes service offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in diabetes care.