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Nas MA, Cayir Y, Bilen A. The impact of teach-back educational method on diabetes knowledge level and clinical parameters in type 2 diabetes patients undergoing insulin therapy. Int J Clin Pract 2021; 75:e13921. [PMID: 33336836 DOI: 10.1111/ijcp.13921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mehmet Akif Nas
- Family Medicine Clinic, Askale State Hospital, Erzurum, Turkey
| | - Yasemin Cayir
- Family Medicine Clinic, Askale State Hospital, Erzurum, Turkey
| | - Arzu Bilen
- Department of Internal Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Khairnar R, Kamal KM, Giannetti V, Dwibedi N, McConaha J. Primary care physician perspectives on barriers and facilitators to self-management of type 2 diabetes. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
To assess physician perspectives on perceived barriers and facilitators to type 2 diabetes self-management (DSM) in a primary care setting.
Methods
The study utilized survey methodology to measure perspectives of primary care physicians on DSM and the challenges they face in managing patients with poor glycaemic stability. Demographic and practice site-related information of the physicians were also collected.
Key findings
Of the 21 physicians who responded (53.8% response rate), 71.2% were aged 50 years or older, 54.2% had ≥25 years of clinical experience, and 50% practiced in an urban setting. The physicians examined 5–60 patients with type 2 diabetes per week (mean = 20), and over 75% of them spent <20 min on face-to-face visits. Approximately, 95% of physicians considered self-care activities such as regular moderate exercise, following a recommended diet, regular blood glucose testing, proper insulin administration and adherence to oral medication as extremely important. Practice-related aspects such as patient–physician communication, patient health literacy and patient follow-up were unanimously considered extremely important, and performance on these measures was rated positively. Interestingly, 66% of physicians felt responsible to some extent for their patient's failure to reach type 2 DSM goals. Physician perceived barriers that contributed to clinical inertia included cost of medications, lack of patient motivation and knowledge, non-compliance with diet and medications, polypharmacy and lack of time and social support.
Conclusions
The study results underscore the importance of DSM in the overall management of type 2 diabetes. Addressing the challenges faced by physicians may result in better self-management and improved clinical outcomes in type 2 diabetes population.
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Affiliation(s)
- Rahul Khairnar
- Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore, Baltimore, MD, USA
| | - Khalid M. Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Vincent Giannetti
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, WV, USA
| | - Jamie McConaha
- Division of Pharmacy Practice, School of Pharmacy, Duquesne University, Pittsburgh, PA, USA
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Kocak MZ, Aktas G, Erkus E, Taslamacioglu Duman T, Atak BM, Savli H. ANALYSIS OF THE TYPE 2 DIABETIC PATIENTS FOLLOWED IN A UNIVERSITY CLINIC. KONURALP TIP DERGISI 2018. [DOI: 10.18521/ktd.345149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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4
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Khairnar R, Kamal KM, Giannetti V, Dwibedi N, McConaha J. Barriers and facilitators to diabetes self-management in a primary care setting - Patient perspectives. Res Social Adm Pharm 2018; 15:279-286. [PMID: 29776663 DOI: 10.1016/j.sapharm.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Diabetes self-management (DSM) is a key element in the overall management of type-2 diabetes (T2DM). Identifying barriers and facilitators to DSM and addressing them is a critical step in achieving improved health outcomes in this population. OBJECTIVE To assess patient reported barriers and facilitators to self-management of T2DM in a primary care setting. METHODS This cross sectional study combined patient survey data with electronic medical record (EMR) data. Patients (age≥18 years) with a recorded diagnosis of T2DM (ICD-9 code: 250. xx) and having ≥2 physician visits were identified from a physician group's EMR database. Patients were grouped based on their A1C levels: <7, 7-9, and >9. Information on demographics, knowledge of diabetes, attitudes, health beliefs, and level of self-management was collected through survey administration. Survey responses were linked to the EMR data, and additional patient information was extracted. RESULTS A total of 2100 surveys were administered (700 in each A1C category) of which 210 responses were received (10% response rate). Mean age was 63.7 years ( ±11.79), 108 (51.4%) were males, and 197 (93.8%) were Caucasian. Age (X2 = 15.73, p < 0.01), insurance status (X2 = 12.03, p < 0.05), referral to an endocrinologist (X2 = 6.17, p < 0.05), level of self-management (X2 = 12.01, p < 0.05) and willingness to use insulin (X2 = 9.8, p < 0.01) were associated with glycemic variability. Level of self-management (X2 = 33.04, p < 0.01) and referral to an endocrinologist (X2 = 11.11, p < 0.01) were associated with readiness to change DSM behavior. Better self-management, older age, lower willingness to use insulin, and 'less than graduate level' education were significant predictors of glycemic stability. CONCLUSIONS Self-management behavior of patients with T2DM is strongly associated with glycemic stability. Interventions directed towards improving self-management in this population may result in improved clinical outcomes.
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Affiliation(s)
- Rahul Khairnar
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, USA
| | - Khalid M Kamal
- School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA.
| | - Vincent Giannetti
- School of Pharmacy, Pharmaceutical, Administrative and Social Sciences, Duquesne University, USA
| | | | - Jamie McConaha
- Pharmacy Practice, School of Pharmacy, Duquesne University, USA
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Maryniuk MD, Bronzini BM, Lorenzi GM. Quality Diabetes Self-Management Education: Achieving and Maintaining ADA Education Program Recognition. DIABETES EDUCATOR 2016; 30:467-75. [PMID: 15208844 DOI: 10.1177/014572170403000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this article is to describe the ADA Education Recognition Program Review Criteria for the National Standards for DSME and to help ADA-Recognized programs be prepared in the event of a random audit. METHODS A multidisciplinary committee defined the Review Criteria and Indicators to demonstrate implementation of the 10 National Standards. Tips for completing the application as well as the 2 types of audits, random paper and onsite, are described. RESULTS Five percent of all ADA-Recognized education programs will receive an onsite review conducted by 2 trained auditors. Detailed steps (based on over 100 audits that have been conducted) are outlined describing what happens prior to and during an audit so education programs can more fully understand the process and be prepared. The most common reasons that applications and/or audits fail are described. CONCLUSIONS The Education Recognition Program of the ADA aims to ensure that diabetes education programs that meet quality standards will reach as many patients as possible. The lessons learned from other program applications and audits help to strengthen all diabetes education services to ensure that educators are doing the best for their patients.
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Affiliation(s)
| | - Blanche M Bronzini
- American Diabetes Association, Recognition Programs, Alexandria, Virginia
| | - Gayle M Lorenzi
- University of California San Diego, Department of Medicine, La Jolla
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6
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Steed L, Lankester J, Barnard M, Earle K, Hurel S, Newman S. Evaluation of the UCL Diabetes Self-management Programme (UCL-DSMP): A Randomized Controlled Trial. J Health Psychol 2016; 10:261-76. [PMID: 15723895 DOI: 10.1177/1359105305049775] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Self-management has been described as the cornerstone of care for diabetes. Many self-management studies are limited by poor methodology and poor descriptions of the intervention. The current study developed a theoretically based self-management programme for patients with type 2 diabetes, which was evaluated via a randomized controlled trial. At immediate post-intervention and three-month follow-up the intervention group showed significant improvement relative to controls on self-management behaviours, quality of life and illness beliefs. A trend towards improved HbA1c was also observed. Documentation in a manual and development of a training programme for facilitators ensures the programme is replicable.
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Affiliation(s)
- Liz Steed
- Royal Free & University College Medical School, London, W1N 8AA, UK
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Ahmad B, Ramadas A, Kia Fatt Q, Zain AZM. A pilot study: the development of a culturally tailored Malaysian Diabetes Education Module (MY-DEMO) based on the Health Belief Model. BMC Endocr Disord 2014; 14:31. [PMID: 24708715 PMCID: PMC4005520 DOI: 10.1186/1472-6823-14-31] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes education and self-care remains the cornerstone of diabetes management. There are many structured diabetes modules available in the United Kingdom, Europe and United States of America. Contrastingly, few structured and validated diabetes modules are available in Malaysia. This pilot study aims to develop and validate diabetes education material suitable and tailored for a multicultural society like Malaysia. METHODS The theoretical framework of this module was founded from the Health Belief Model (HBM). The participants were assessed using 6-item pre- and post-test questionnaires that measured some of the known HBM constructs namely cues to action, perceived severity and perceived benefit. Data was analysed using PASW Statistics 18.0. RESULTS The pre- and post-test questionnaires were administered to 88 participants (31 males). In general, there was a significant increase in the total score in post-test (97.34 ± 6.13%) compared to pre-test (92.80 ± 12.83%) (p < 0.05) and a significant increase in excellent score (>85%) at post-test (84.1%) compared to pre-test (70.5%) (p < 0.05). There was an improvement in post-test score in 4 of 6 items tested. The remaining 2 items which measured the perceived severity and cues to action had poorer post-test score. CONCLUSIONS The preliminary results from this pilot study suggest contextualised content material embedded within MY DEMO maybe suitable for integration with the existing diabetes education programmes. This was the first known validated diabetes education programme available in the Malay language.
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Affiliation(s)
- Badariah Ahmad
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Malaysia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Malaysia
| | - Quek Kia Fatt
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Malaysia
| | - Anuar Zaini Md Zain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Malaysia
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8
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Eigenmann CA, Skinner T, Colagiuri R. Development and validation of a diabetes knowledge questionnaire. ACTA ACUST UNITED AC 2011. [DOI: 10.1002/pdi.1586] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Kushner RF, Graham T, Hegazi R, Jensen G, Marik P, Merritt R. Optimizing Integration of Nutrition Into Patient Care Through Physician Leadership. JPEN J Parenter Enteral Nutr 2010; 34:30S-9S. [DOI: 10.1177/0148607110373931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert F. Kushner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Toby Graham
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Gordon Jensen
- Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania
| | - Paul Marik
- Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Russell Merritt
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
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10
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Mayberry R, Willock RJ, Boone L, Lopez P, Qin H, Nicewander D. A High Level of Patient Activation Is Observed But Unrelated to Glycemic Control Among Adults With Type 2 Diabetes. Diabetes Spectr 2010; 23:171-176. [PMID: 26005310 PMCID: PMC4438273 DOI: 10.2337/diaspect.23.3.171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure patient activation and its relationship to glycemic control among adults with type 2 diabetes who had not participated in a formal diabetes self-management education program as a baseline assessment for tailoring diabetes education in a primary care setting. RESEARCH DESIGN AND METHODS Patient activation was assessed in a stratified, cross-sectional study of adults with controlled (n = 21) and uncontrolled (n = 27) type 2 diabetes, who were receiving primary care at a unique family practice center of Baylor Health Care System in Dallas, Tex. RESULTS The mean patient activation was 66.0 (95% confidence interval [CI] 60.8-71.2) among patients with uncontrolled diabetes and 63.7 (55.9-71.5) among those with controlled diabetes (P = 0.607). A significant association was observed between the self-management behavior score and activation among patients whose glycemia was under control (ρ = 0.73, P = 0.01) as well as among patients with uncontrolled glycemia (ρ = 0.48, P < 0.001). CONCLUSIONS Although activation is correlated with self-management and may be important in tailored patient-centered approaches to improving diabetes care outcomes, the highest stage of activation may be necessary to achieve glycemic control. These findings reinforce the importance of conducting prerequisite needs assessments so diabetes educators are able to tailor their educational interventions to individual patients' needs and readiness to take action.
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Affiliation(s)
- Robert Mayberry
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
| | - Robina Josiah Willock
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
| | - Leslie Boone
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
| | - Patricia Lopez
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
| | - Huanying Qin
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
| | - David Nicewander
- The authors were all from the Baylor Health Care System Institute for Health Care Research and Improvement in Dallas, Tex. Robert Mayberry, MS, MPH, PhD, was director of Health Equity Research, Robina Josiah Willock, MPH, PhD, was a health services researcher, Leslie Boone, MPH, was associate director for research administration, and Patricia Lopez, MS, was a research associate in the institute's Equity Research Group. Huanying Qin, MS, is a biostatistician, and David Nicewander, MS, is director and biostatistician of Analytical Tools and Programming in the institute's Quantitative Services Group
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Li R, Zhang P, Barker L, Hartsfield D. Impact of state mandatory insurance coverage on the use of diabetes preventive care. BMC Health Serv Res 2010; 10:133. [PMID: 20492699 PMCID: PMC2881060 DOI: 10.1186/1472-6963-10-133] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 05/21/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND 46 U.S. states and the District of Columbia have passed laws and regulations mandating that health insurance plans cover diabetes treatment and preventive care. Previous research on state mandates suggested that these policies had little impact, since many health plans already covered the benefits. Here, we analyze the contents of and model the effect of state mandates. We examined how state mandates impacted the likelihood of using three types of diabetes preventive care: annual eye exams, annual foot exams, and performing daily self-monitoring of blood glucose (SMBG). METHODS We collected information on diabetes benefits specified in state mandates and time the mandates were enacted. To assess impact, we used data that the Behavioral Risk Factor Surveillance System gathered between 1996 and 2000. 4,797 individuals with self-reported diabetes and covered by private insurance were included; 3,195 of these resided in the 16 states that passed state mandates between 1997 and 1999; 1,602 resided in the 8 states or the District of Columbia without state mandates by 2000. Multivariate logistic regression models (with state fixed effect, controlling for patient demographic characteristics and socio-economic status, state characteristics, and time trend) were used to model the association between passing state mandates and the usage of the forms of diabetes preventive care, both individually and collectively. RESULTS All 16 states that passed mandates between 1997 and 1999 required coverage of diabetic monitors and strips, while 15 states required coverage of diabetes self management education. Only 1 state required coverage of periodic eye and foot exams. State mandates were positively associated with a 6.3 (P = 0.04) and a 5.8 (P = 0.03) percentage point increase in the probability of privately insured diabetic patient's performing SMBG and simultaneous receiving all three preventive care, respectively; state mandates were not significantly associated with receiving annual diabetic eye (0.05 percentage points decrease, P = 0.92) or foot exams (2.3 percentage points increase, P = 0.45). CONCLUSIONS Effects of state mandates varied by preventive care type, with state mandates being associated with a small increase in SMBG. We found no evidence that state mandates were effective in increasing receipt of annual eye or foot exams. The small or non-significant effects might be attributed to small numbers of insured people not having the benefits prior to the mandates' passage. If state mandates' purpose is to provide improved benefits to many persons, policy makers should consider determining the number of people who might benefit prior to passing the mandate.
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Affiliation(s)
- Rui Li
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, USA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, USA
| | - Lawrence Barker
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, USA
| | - DeKeely Hartsfield
- The National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, USA
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12
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Abstract
In persons with diabetes mellitus, atherosclerosis is increased, develops prematurely, and is associated with an accelerated progression of atherosclerotic changes. More than 55% of deaths from diabetes are from cardiovascular disease. Central to the optimal management of diabetes and the prevention of chronic complications is effective patient education. The necessity of optimal glycemic control in the prevention of long-term diabetes-related complications, particularly microvascular disease, has been a primary focus of diabetes education during the past decade. It has become clear that to prevent cardiovascular disease in persons with diabetes, an increased emphasis on patient education aimed at reducing cardiovascular disease risk factors is essential. This review explores the scope, impact, and prevention of diabetes-related cardiovascular disease, focusing on integration of cardiovascular disease risk reduction during patient teaching and education programs.
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Affiliation(s)
- Laurie Quinn
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with Type 2 diabetes mellitus. Br J Clin Pharmacol 2009; 67:547-57. [PMID: 19552750 PMCID: PMC2686072 DOI: 10.1111/j.1365-2125.2009.03391.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Accepted: 02/03/2009] [Indexed: 11/27/2022] Open
Abstract
AIMS To examine the influence of a pharmaceutical care programme on disease control and health-related quality of life in Type 2 diabetes patients in the United Arab Emirates. METHODS A total of 240 Type 2 diabetes patients were recruited into a randomized, controlled, prospective clinical trial with a 12-month follow-up. A range of clinical measures, medication adherence and health-related quality of life (Short Form 36) were evaluated at baseline and up to 12 months. Intervention group patients received pharmaceutical care from a clinical pharmacist, whereas control group patients received their usual care from medical and nursing staff. The primary outcome measure was change in HbA(1c). British National Formulary and Framingham scoring methods were used to estimate changes in 10-year coronary heart disease risk scores in all patients. RESULTS A total of 234 patients completed the study. Significant reductions (P < 0.001) in mean values (baseline vs. 12 months; 95% confidence interval) of HbA(1c)[8.5% (8.3, 8.7) vs. 6.9% (6.7, 7.1)], systolic [131.4 mmHg (128.1, 134.7) vs. 127.2 mmHg (124.4, 130.1)] and diastolic blood pressure [85.2 mmHg (83.5, 86.8) vs. 76.3 mmHg (74.9, 77.7)] were observed in the intervention group; no significant changes were noted in the control group. The mean Framingham risk prediction score in the intervention group was 10.56% (9.7, 11.4) at baseline; this decreased to 7.7% (6.9, 8.5) (P < 0.001) at 12 months but remained unchanged in the control group. CONCLUSIONS The pharmaceutical care programme resulted in better glycaemic control and reduced cardiovascular risk scores in Type 2 diabetes patients over a 12-month period.
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Boren SA, De Leo G, Chanetsa FF, Donaldson J, Krishna S, Balas EA. Evaluation of a Diabetes Education Call Center Intervention. Telemed J E Health 2006; 12:457-65. [PMID: 16942418 DOI: 10.1089/tmj.2006.12.457] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients require education and information as they engage in self-help, self-care, and disease management activities. The purpose of this study was to determine how effective voice technologies are in diabetes patient education. A pretest-posttest study was conducted to evaluate the effectiveness of prerecorded educational messages delivered via the telephone to participants with diabetes. The intervention consisted of 24 four-minute messages on the topics of knowledge and prevention, glucose level, diet and activity, and management and coping. Eighteen persons with diabetes participated in the pretest-posttest trial. A total of 324 educational messages were listened to over a 12-week intervention period. The pretest-posttest trial demonstrated that a brief telephone-based diabetes education intervention can have a significant impact on increasing frequency of checking blood for glucose (p = 0.017), improving general diabetes knowledge (p = 0.048), and improving insulin-specific knowledge (p = 0.020). Automated educational interventions should be based on scientifically sound evidence and can be effectively delivered by telephone. Automated telephone-based diabetes education may be used alone or as a supplement to existing diabetes education. Automated education is a viable solution when healthcare organizations and regions that as a result of a lack of human and financial resources cannot afford a diabetes educator.
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15
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Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus. J Clin Psychol Med Settings 2006. [DOI: 10.1007/s10880-006-9034-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dickerson FB, Goldberg RW, Brown CH, Kreyenbuhl JA, Wohlheiter K, Fang L, Medoff D, Dixon LB. Diabetes knowledge among persons with serious mental illness and type 2 diabetes. PSYCHOSOMATICS 2005; 46:418-24. [PMID: 16145186 DOI: 10.1176/appi.psy.46.5.418] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Type 2 diabetes is an important medical condition associated with serious mental illness. The authors studied the disease-specific knowledge about diabetes in a sample of 201 psychiatric outpatients with a diagnosis of schizophrenia or major mood disorders, all of whom had type 2 diabetes. In a multivariate analysis, disease-specific diabetes knowledge was associated with higher cognitive functioning, a higher level of education, and recent receipt of diabetes education. Disease-specific diabetes knowledge predicted lower levels of perceived barriers to diabetes care. Gaps in diabetes knowledge may be reduced by specialized interventions that take into account the cognitive deficits of persons with serious mental illness.
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Affiliation(s)
- Faith B Dickerson
- Sheppard Pratt Health System, 6501 N. Charles St., Baltimore, MD 21204, USA.
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Deakin T, McShane CE, Cade JE, Williams RDRR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005:CD003417. [PMID: 15846663 DOI: 10.1002/14651858.cd003417.pub2] [Citation(s) in RCA: 422] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been recognised that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. However, the most effective method for delivering education and teaching self-management skills is unclear. OBJECTIVES To assess the effects of group-based, patient-centred training on clinical, lifestyle and psychosocial outcomes in people with type 2 diabetes. SEARCH STRATEGY Studies were obtained from computerised searches of multiple electronic bibliographic databases, supplemented by hand searches of reference lists of articles, conference proceedings and consultation with experts in the field. Date of last search was February 2003. SELECTION CRITERIA Randomised controlled and controlled clinical trials which evaluated group-based education programmes for adults with type 2 diabetes compared with routine treatment, waiting list control or no intervention. Studies were only included if the length of follow-up was six months or more and the intervention was at least one session with the minimum of six participants. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed study quality. A meta-analysis was performed if there were enough homogeneous studies reporting an outcome at either four to six months, 12-14 months, or two years, otherwise the studies were summarised in a descriptive manner. MAIN RESULTS Fourteen publications describing 11 studies were included involving 1532 participants. The results of the meta-analyses in favour of group-based diabetes education programmes were reduced glycated haemoglobin at four to six months (1.4%; 95% confidence interval (CI) 0.8 to 1.9; P < 0.00001), at 12-14 months (0.8%; 95% CI 0.7 to 1.0; P < 0.00001) and two years (1.0%; 95% CI 0.5 to 1.4; P < 0.00001); reduced fasting blood glucose levels at 12 months (1.2 mmol/L; 95% CI 0.7 to 1.6; P < 0.00001); reduced body weight at 12-14 months (1.6 Kg; 95% CI 0.3 to 3.0; P = 0.02); improved diabetes knowledge at 12-14 months (SMD 1.0; 95% CI 0.7 to 1.2; P < 0.00001) and reduced systolic blood pressure at four to six months (5 mmHg: 95% CI 1 to 10; P = 0.01). There was also a reduced need for diabetes medication (odds ratio 11.8, 95% CI 5.2 to 26.9; P < 0.00001; RD = 0.2; NNT = 5). Therefore, for every five patients attending a group-based education programme we could expect one patient to reduce diabetes medication. AUTHORS' CONCLUSIONS Group-based training for self-management strategies in people with type 2 diabetes is effective by improving fasting blood glucose levels, glycated haemoglobin and diabetes knowledge and reducing systolic blood pressure levels, body weight and the requirement for diabetes medication.
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Affiliation(s)
- T Deakin
- Department of Nutrition & Dietetics, Burnley, Pendle & Rossendlae Primary Care Trust, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire, UK, BB10 2PQ.
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Shane-McWhorter L, Oderda GM. Providing Diabetes Education and Care to Underserved Patients in a Collaborative Practice at a Utah Community Health Center. Pharmacotherapy 2005; 25:96-109. [PMID: 15767225 DOI: 10.1592/phco.25.1.96.55623] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many underserved patients in Utah lack insurance coverage for health care and prescription drugs but are provided medical care in community health centers (CHCs). Before June 2000, comprehensive pharmacy services were not provided to these patients at a Utah CHC. As part of a Health Resources and Services Administration grant, a collaborative agreement between the University of Utah College of Pharmacy and Utah CHCs was established so that a faculty clinician who is a certified diabetes educator (CDE) could provide diabetes education and care to underserved patients. The College of Pharmacy faculty clinician (pharmacist CDE) collaborated with physicians and midlevel practitioners to provide diabetes education and care for 176 patients. In addition to initial diabetes education, the pharmacist CDE provided continuing disease management by providing information and feedback to patients and recommendations to providers. The pharmacist CDE conducted continuing chart reviews to track certain parameters, such as laboratory test results for hemoglobin A 1c (A1C) and lipid levels, and blood pressure. Patients were followed for 1-3 years. The same outcome data were also collected for 176 patients with diabetes mellitus in another CHC clinic to provide a comparison group. Total cholesterol, low-density lipoprotein cholesterol, A1C, and triglyceride levels declined significantly from baseline at both sites. However, more patients who were provided care by the pharmacist CDE reached the American Diabetes Association A1C target goal of below 7%.
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Affiliation(s)
- Laura Shane-McWhorter
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah 84112, USA
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Abstract
An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.
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Affiliation(s)
- Stanton Newman
- Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, London, UK.
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Frable PJ, Wallace DC, Ellison KJ. Using clinical guidelines in home care: for patients with diabetes. HOME HEALTHCARE NURSE 2004; 22:462-8. [PMID: 15241197 DOI: 10.1097/00004045-200407000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Pamela Jean Frable
- Harris School of Nursing, Texas Christian University, Fort Worth, TX, USA
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Abstract
Providing individualized education to home care patients with diabetes can significantly improve their foot care practices. A nurse researcher from the Intercollegiate College of Nursing at Washington State University conducted a study of 40 home healthcare patients with Type 2 diabetes and found that an individualized educational intervention led to improved foot care knowledge, self-care practices, and confidence performing foot related self-care.
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Affiliation(s)
- Sheila Neder
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, NY 10001-1810, USA.
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Abstract
The article reviews gestational diabetes mellitus, including etiology, diagnostic and screening criteria, risk factors, and care of the affected woman. Gestational diabetes mellitus affects approximately 7% of all pregnant women, resulting in more than 200,000 cases each year, and is defined as glucose intolerance that begins or is first recognized during pregnancy. Women are considered at high risk for gestational diabetes if they are markedly obese, have a personal history of gestational diabetes, have a strong family history of diabetes, or have glycosuria. Risk assessment is essential in determining whether a woman should be screened or tested for gestational diabetes. Women who have had gestational diabetes should have comprehensive preconception care prior to a subsequent pregnancy to ascertain appropriate weight, nutrition, exercise, and signs of gestational diabetes.
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Affiliation(s)
- Marian Farrell
- University of Scranton, Room 307 McGurrin Hall, Scranton, PA 18510, USA.
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Franz MJ. The Lenna Francis Cooper Memorial Lecture--The future of clinical dietetics: evidence, outcomes, and reimbursement. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2003; 103:977-81. [PMID: 12891145 DOI: 10.1016/s0002-8223(03)00969-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marion J Franz
- Nutrition Concepts by Franz, Inc., 6635 Limerick Drive, Minneapolis, MN 55439, USA.
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