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Wicaksana AL, Apriliyasari RW, Tsai PS. Effect of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes: A meta-analysis of randomized controlled trials. Int J Nurs Stud 2024; 149:104626. [PMID: 37979371 DOI: 10.1016/j.ijnurstu.2023.104626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Self-help interventions are beneficial for patients with diabetes; however, related studies have reported conflicting results. To date, no review has examined the effect of self-help interventions on diabetes outcomes. OBJECTIVES To systematically evaluate the effects of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS Five databases-PubMed, CINAHL, Embase, PsycINFO, and ClinicalTrials.gov-were searched from 1996, 1937, 1947, 1887, and 2000, respectively, to 2 June 2023. Studies that employed a randomized controlled trial design, enrolled adults with diabetes, implemented a self-help intervention as the main or an additional intervention, and reported the outcomes of interest were included. Studies providing self-help interventions to patients with gestational diabetes or pregnant women were excluded. The primary outcomes were diabetes distress, depression, and anxiety, and the secondary outcomes were glycemic and behavioral outcomes (self-management behavior, self-efficacy, and quality of life). Hedges' g and the associated 95 % confidence interval (CI) were calculated using a random-effects model to obtain the pooled estimates of short-, mid-, and long-term effects of self-help interventions. Heterogeneity was explored using I2 and Q statistics, and moderator analysis was performed to identify the sources of heterogeneity. RESULTS Of 17 eligible studies, 16 provided data for meta-analysis. We included 3083 patients with diabetes; the majority were women (61.95 %), and their average age was 55.13 years. Self-help interventions exerted significant short-term effects on diabetes distress (g = -0.363; 95 % CI = -0.554, -0.173), depression (g = -0.465; 95 % CI = -0.773, -0.156), anxiety (g = -0.295; 95 % CI = -0.523, -0.068), glycosylated hemoglobin level (g = -0.497; 95 % CI = -0.791, -0.167), self-efficacy (g = 0.629; 95 % CI = 0.060, 1.197), and quality of life (g = 0.413; 95 % CI = 0.104, 0.721; g = 0.182; 95 % CI = 0.031, 0.333; and g = 0.469; 95 % CI = 0.156, 0.783 for overall, physical, and mental domains, respectively). We also noted significant mid-term effects of self-help interventions on diabetes distress (g = -0.195; 95 % CI = -0.374, -0.016), self-management behavior (g = 0.305; 95 % CI = 0.155, 0.454), and overall quality of life (g = 0.562; 95 % CI = 0.315, 0.810). The certainty of evidence ranged from high to very low certainty for the measured outcomes. CONCLUSIONS Self-help interventions may have some positive effects on diabetes distress, anxiety, self-management behavior, and quality of life. REGISTRATION This review was registered in PROSPERO (CRD42022329905). TWEETABLE ABSTRACT This meta-analysis demonstrated that self-help interventions might improve psychological and behavioral outcomes in patients with diabetes.
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Affiliation(s)
- Anggi Lukman Wicaksana
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Medical Surgical Nursing, Universitas Gadjah Mada, Indonesia; The Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Indonesia
| | - Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Institut Teknologi Kesehatan Cendekia Utama Kudus, Kudus, Indonesia
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing and Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
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Degefa G, Wubshet K, Tesfaye S, Hirigo AT. Predictors of Adherence Toward Specific Domains of Diabetic Self-Care Among Type-2 Diabetes Patients. Clin Med Insights Endocrinol Diabetes 2020; 13:1179551420981909. [PMID: 33424232 PMCID: PMC7755941 DOI: 10.1177/1179551420981909] [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] [Received: 09/19/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Adequate knowledge, awareness, and adherence to diabetic self-care practices are vital tools to protect patients from risks of disease complications, developing comorbidity and mortality. Therefore, this study aimed to assess specific domains of diabetic self-care practice and associated factors among patients with type-2diabetes in Hawassa University Comprehensive Specialized Hospital, Sidama regional state. MATERIALS AND METHODS A hospital-based cross-sectional study design was conducted on 217 patients with type 2 diabetes from January 01 to April 30, 2020. A structured questionnaire and the Summary of Diabetes Self-Care Activities (SDSCA) tool were used to collect relevant data through interviewer administration. Statistical analysis was done using SPSS version 23. RESULTS A total of 207 patients with type-2 diabetes were participated in the study with a 95% response rate. Overall 47.8% (95%CI: 41.2-55) of patients adhered to diabetic self-care practice. Concerning the specific domain of self-care practice, 54.6%, 39.1%, 28%, and 65.2% of patients adhered to a healthy diet, physical exercise, self-monitoring blood glucose (SMBG), and diabetic foot care practices, respectively. Besides, all patients received at least 80% of the prescribed doses and frequency of anti-diabetic agents and 60.4% had good glycemic control. Receipt of advice from treating physicians and having no familial history of diabetes were significantly associated with adherence toward eating a healthy diet, diabetic foot care, and SMBG. While male sex was associated with adherence toward healthy diet management. Moreover, having glucometer, age, male sex, diabetes duration ⩾ 5 years, and anti-diabetic treatment modality were associated with adherence toward SMBG. CONCLUSION This study indicates 52.2%, 72%, and 60.1% of diabetes patients did not adhere to diabetic self-care, SMBG, and physical exercise, respectively. Improving awareness and regular diabetic education is imperative to scale up patients' adherence toward diabetic self-care practice.
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Affiliation(s)
- Girma Degefa
- Department of Internal Medicine, Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Sidama Regional State, Southern-Ethiopia
| | - Kindie Wubshet
- Department of Internal Medicine, Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Sidama Regional State, Southern-Ethiopia
| | - Sisay Tesfaye
- Department of Internal Medicine, Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Sidama Regional State, Southern-Ethiopia
| | - Agete Tadewos Hirigo
- School of Medical Laboratory Sciences, Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Sidama Regional State, Southern-Ethiopia
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Lee EH, Lee YW, Lee KW, Hong S, Kim SH. A New Objective Health Numeracy Test for Patients with Type 2 Diabetes: Development and Evaluation of Psychometric Properties. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:66-72. [DOI: 10.1016/j.anr.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
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López-Goerne T, Ramírez P, Alvarez D, Rodríguez-Reinoso F, Silvestre-Albero AM, Gómez E, Rodríguez-Castellon E. Physicochemical properties and in vivo evaluation of Pt/TiO 2-SiO 2 nanopowders. Nanomedicine (Lond) 2018; 13:2171-2185. [PMID: 30277422 DOI: 10.2217/nnm-2018-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM Sol-gel is a suitable and advantageous method to synthesize mixed oxide nanomaterials with unique physicochemical and biological properties. MATERIALS & METHODS In this work, TiO2-SiO2 nanopowders cogeled with platinum acetylacetonate were developed and studied in the perspective of nanomedicine. The physicochemical properties of the Pt/TiO2-SiO2 nanopowders, named NanoRa2-Pt, were evaluated in detail by means of complementary spectroscopic and microscopic tools. The nanopowder's biocatalytic efficiency in wound healing was evaluated in a Type I diabetes animal model. RESULTS These are TiO2-SiO2 submicron mesoporous particles with variable size and shape containing ultra-small platinum nanoparticles with catalytic properties. CONCLUSION The use of NanoRa2-Pt catalyzes the natural healing processes with a faster remodeling stage. These sols, which we call nanobiocatalysts, belong to an emerging and very promising research field known as catalytic nanomedicine.
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Affiliation(s)
- Tessy López-Goerne
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Institute of Physics, UNAM, Circuito de la Investigación Científica Ciudad Universitaria, 04510 Mexico City, Mexico
| | - Paola Ramírez
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Laboratorios de Nanomedicina y Nanotecnología. Nano Tutt S.A. de C.V. México City, México
| | - Daniel Alvarez
- Nanotechnology & Nanomedicine Laboratory, Universidad Autónoma Metropolitana-Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, 04960 Mexico City, Mexico.,Laboratorios de Nanomedicina y Nanotecnología. Nano Tutt S.A. de C.V. México City, México
| | - Francisco Rodríguez-Reinoso
- Advanced Materials Laboratory, Departamento de Química Inorgánica, Universidad de Alicante, Apartado 99, 03080 Alicante, Spain
| | - Ana M Silvestre-Albero
- Advanced Materials Laboratory, Departamento de Química Inorgánica, Universidad de Alicante, Apartado 99, 03080 Alicante, Spain
| | - Esteban Gómez
- AG Nano Optik, Institut für Physik, Humboldt-Universität zu Berlin, Newtonstrasse 15, 12489 Berlin, Germany
| | - Enrique Rodríguez-Castellon
- Universidad de Málaga, Facultad de Ciencias, Departamento de Química Inorgánica, Cristalografía y Mineralogía, 29071 Málaga, Spain
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Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on the management of diabetic foot ulcer. World J Diabetes 2015; 6:37-53. [PMID: 25685277 PMCID: PMC4317316 DOI: 10.4239/wjd.v6.i1.37] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/22/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications.
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Grinslade S, Paper B, Jing H, Quinn L. Development and Psychometric Evaluation of the Diabetes Self-Efficacy Scale. J Nurs Meas 2015; 23:40-56. [DOI: 10.1891/1061-3749.23.1.40] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: No scales measure self-efficacy in women with Type 2 diabetes. A scale was developed and tested. Methods: Items generated, content validity index (CVI) assessed by experts, the 2-part Diabetes Self-Efficacy Scale (DSLF-I and DSLF-II) was piloted with 62 women, administered to 208 women, and then readministered to 30 women to determine initial reliability. Factor analysis was conducted for construct validity. Discriminant, convergent, and predictive validity was examined. Results: The CVI index was 98%. Cronbach’s alphas were 0.88 (DSLF-I) and 0.82 (DSLF-II; pilot) and 0.87 and 0.86, respectively (main study); test–retest correlation was .60 (DSLF-I) and .69 (DSLF-II). There were 3 factors that emerged: diabetes knowledge of self-care activity, diabetes diet self-care, and diabetes medication self-care. Conclusions: The Diabetes Self-Efficacy Scale demonstrates good initial reliability and validity.
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Valadares ALR, Machado VSS, Costa-Paiva LS, de Sousa MH, Pinto-Neto AM. Factors associated with the age of the onset of diabetes in women aged 50 years or more: a population-based study. BMJ Open 2014; 4:e004838. [PMID: 25428628 PMCID: PMC4248098 DOI: 10.1136/bmjopen-2014-004838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Investigate factors associated with the onset of diabetes in women aged more than 49 years. DESIGN AND METHODS Cross-sectional, population-based study using self-reports with 622 women. The dependent variable was the age of occurrence of diabetes using the life table method. Cox multiple regression models were adjusted to analyse the onset of diabetes according to predictor variables. Sociodemographic, clinical and behavioural factors were evaluated. RESULTS Of the 622 women interviewed, 22.7% had diabetes. The mean age at onset was 56 years. The factors associated with the age of occurrence of diabetes were self-rated health (very good, good) (coefficient=-0.792; SE of the coefficient=0.215; p=0.0001), more than two individuals living in the household (coefficient=0.656, SE of the coefficient=0.223; p=0.003), and body mass index (BMI) (kg/m(2)) at 20-30 years of age (coefficient= 0.056, SE of the coefficient=0.023; p=0.014). CONCLUSIONS Self-rated health considered good or very good was associated with a higher rate of survival without diabetes. Sharing a home with two or more other people and a weight increase at 20-30 years of age was associated with the onset of type 2 diabetes.
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Affiliation(s)
- Ana L R Valadares
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Vanessa S S Machado
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Lúcia S Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maria H de Sousa
- Department of Statistics, Campinas Center for Research in Reproductive Health (CEMICAMP), UNICAMP, Campinas, Brazil
| | - Aarão M Pinto-Neto
- Department of Obstetrics and Gynecology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
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Grillo MDFF, Neumann CR, Scain SF, Rozeno RF, Gross JL, Leitão CB. Effect of different types of self-management education in patients with diabetes. Rev Assoc Med Bras (1992) 2013; 59:400-5. [PMID: 23850026 DOI: 10.1016/j.ramb.2013.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/30/2012] [Accepted: 02/11/2013] [Indexed: 11/29/2022] Open
Abstract
Education plays an important role in diabetes mellitus (DM) treatment, as it enables patients to manage their disease. There is a wide range of tested educational interventions, and, to date, no universal model that can be standardized and recognized as effective for all individuals with the disease has been defined. This article aims to review the effect of different types of educational interventions for self-management of glycemic control in patients with DM type 2, in addition to define general recommendations for this treatment strategy.
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Chellan G, Srikumar S, Varma AK, Mangalanandan TS, Sundaram KR, Jayakumar RV, Bal A, Kumar H. Foot care practice - the key to prevent diabetic foot ulcers in India. Foot (Edinb) 2012; 22:298-302. [PMID: 22999359 DOI: 10.1016/j.foot.2012.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 08/20/2012] [Accepted: 08/21/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND The magnitude of diabetic foot ulcers (DFUs) and the amputation rates due to DFUs remain high even in developing and developed countries. Yet, the influence of knowledge, attitude, and practice (KAP) of diabetic foot care (DFC) on DFU incidence is not studied much. OBJECTIVE To study causal relationship between knowledge, attitude and practice (KAP) on DFC between diabetic patients with and without DFUs; and the risk factors associated with DFUs. METHODS A consecutive of 203 diabetic patients (103 with DFU and 100 without DFU) were included in the study. Their demographic details, medical history, and personal habits were recorded. KAP on DFC was assessed using a questionnaire. Responses were recorded, scored, and analyzed. RESULTS Of the cohort, 67.5% were males, mean age: 59.9 ± 11.4 years. Patients without DFU had good knowledge on DFC compared to those with DFU (86% versus 69.9%) (p<0.001). Incidence of DFU was 9% and 39.8% (p<0.001) among patients who practiced and not practiced DFC respectively. 88% patients with and without DFUs; showed favorable attitude toward adopting DFC. Risk factors - diabetic peripheral neuropathy, peripheral vascular disease, retinopathy, nephropathy, smoking, tobacco chewing and alcohol consumption were significantly (p<0.001) associated with DFUs. CONCLUSIONS An inverse relationship between DFU and foot care knowledge as well as practice was observed. Apart from tight glycemic control, diabetic patients must be educated and motivated on proper foot care practice and life style modifications for preventing DFUs.
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Affiliation(s)
- Gopi Chellan
- Department of Endocrinology, Diabetes and Podiatric Surgery, School of Medicine, Amrita Institute of Medical Sciences and Research Center, Kerala, India.
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10
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Donohue-Porter P. Nursing's role in courage development in patients facing complications of diabetes. J Holist Nurs 2012; 31:49-61. [PMID: 23023823 DOI: 10.1177/0898010112461975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to explore the experience of nurses in relation to courage development in patients with disabling complications of diabetes. The phenomenon of courage has been explored in philosophy, theology, literature, and other fields of inquiry rooted in the humanities. Nursing inquiry has not often been directed toward an exploration of courage, although coping, compassion, caring, and other experiences integral to the nurse-patient relationship have been examined. The holistic view of the cascading effect of complications on the individual patient is often overlooked. This qualitative study used phenomenological inquiry and included face-to-face interviews of nurses to explore their experience in assisting patients in the development of courage. The experience of courage is investigated as it relates to a specific group of patients who have complications of diabetes. Four categories representing the unique opportunities for courage development by nurses were generated. These categories included education, advocacy, relationship building, and humanization. Each category described nursing intentions and actions and taken together formed an essential structure of courage development. Conclusions indicated that nurses recognize and are able to describe their role in courage development. Implications for improved health through deliberate caring nursing interventions, aimed at courage development, are presented.
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Franzen E, Scain SF, Záchia SA, Schmidt ML, Rabin EG, Rosa NGD, Menegon DB, Santos LBD, Heldt E. Consulta de enfermagem ambulatorial e diagnósticos de enfermagem relacionados a características demográficas e clínicas. Rev Gaucha Enferm 2012; 33:42-51. [DOI: 10.1590/s1983-14472012000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Trata-se de um estudo que verificou a relação entre as características demográficas e clínicas com os diagnósticos de enfermagem definidos durante a consulta com enfermeira em ambulatório de um hospital geral. É um estudo transversal, que avaliou 237 consultas de enfermagem de pacientes atendidos no Programa de Saúde da Mulher (46 em enfermagem obstétrica e 24 em enfermagem em mastologia) e 167 no Programa de Educação em Diabetes Melito. Foram identificados 49 diagnósticos de enfermagem. Os mais frequentes no programa de saúde da mulher foram: Conhecimento deficiente, Conforto prejudicado, Integridade tissular prejudicada e Ansiedade. No programa de educação em diabetes: Controle ineficaz do regime terapêutico e Nutrição desequilibrada: mais do que as necessidades corporais. Foi encontrada associação significativa entre os diagnósticos mais frequentes com determinadas características demográficas e clínicas. Os resultados confirmaram que a identificação dos diagnósticos de enfermagem durante a consulta pode propiciar acurácia nos focos de cuidado ambulatorial.
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Affiliation(s)
| | | | | | | | - Eliane G. Rabin
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
| | | | | | | | - Elizeth Heldt
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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Martin D, Lange K, Sima A, Kownatka D, Skovlund S, Danne T, Robert JJ. Recommendations for age-appropriate education of children and adolescents with diabetes and their parents in the European Union. Pediatr Diabetes 2012; 13 Suppl 16:20-8. [PMID: 22931221 DOI: 10.1111/j.1399-5448.2012.00909.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Education is the keystone of diabetes care, and structured self-management education is the key to a successful outcome. Existing guidelines provide comprehensive guidance on the various aspects of education and offer general and organizational principles of education, detailed curricula at different ages and stages of diabetes, and recommendations on models, methods, and tools to attain educative objectives. The International Society for Pediatric and Adolescent Diabetes guidelines give the most elaborate and detailed descriptions and recommendations on the practice of education, which other national guidelines address on specific aspects of education and care. The aim of the work package on education developed by Better Control in Paediatric and Adolescent Diabetes in the European Union: Working to Create Centers of Reference (SWEET) project was not to generate new guidelines but to evaluate how the existing guidelines were implemented in some pediatric diabetes reference centers. The SWEET members have completed a questionnaire that elaborates on the many aspects of delivery of education. This survey highlights a profound diversity of practices across centers in Europe, in terms of organization as well as the practices and the content of initial and continuing education. A toolbox is being developed within SWEET to facilitate exchanges on all aspects of education and to establish a process of validation of materials, tools, written structured age-adjusted programs, and evaluation procedures for the education of children and adolescents with diabetes.
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Affiliation(s)
- Delphine Martin
- Hôpital Necker-Enfants Malades, Université René Descartes, Sorbonne Paris Cité, 149 rue de Sèvres, Paris Cedex 15, France
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Piatt GA, Songer TJ, Brooks MM, Anderson RM, Simmons D, Orchard TJ, Siminerio LM, Korytkowski MT, Zgibor JC. Impact of patient level factors on the improvement of the ABCs of diabetes. PATIENT EDUCATION AND COUNSELING 2011; 82:266-270. [PMID: 20434290 DOI: 10.1016/j.pec.2010.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 02/04/2010] [Accepted: 04/02/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine which patient factors contribute to improvements in the ABCs of diabetes following a multi-faceted diabetes care intervention. METHODS A multi-level, cluster design, randomized controlled trial examined the effectiveness of a Chronic Care Model (CCM) intervention in an underserved community (n=119). RESULTS Improvements in glycemic control were experienced among older subjects (p=0.02), those with higher scores on the WHO-10 Quality of Well-Being Subscale 1 (p=0.05), and those in the CCM group (p=0.04). Insulin use was associated with greater improvements in SBP and DBP. Those taking insulin (p=0.07), and those more satisfied with their diabetes care and ready to make a behavior change (p=0.08) experienced larger improvements in Non-HDLc. Medication treatment intensification (TI) did not significantly impact the ABCs. CONCLUSION Psychosocial and sociodemographic factors explained more of the variation in the ABCs than TI, and are important contributors to clinical improvement. PRACTICE IMPLICATIONS Providers may be able to identify and intervene on patients who are at risk for developing diabetes complications and improve the consistency, quality, and effectiveness of patient care.
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Affiliation(s)
- Gretchen A Piatt
- Division of Endocrinology and Metabolism, University of Pittsburgh, PA, USA.
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Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Aman J, Aanstoot HJ, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE. Target setting in intensive insulin management is associated with metabolic control: the Hvidoere childhood diabetes study group centre differences study 2005. Pediatr Diabetes 2010; 11:271-8. [PMID: 19895567 DOI: 10.1111/j.1399-5448.2009.00596.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on metabolic control. METHODS Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally. RESULTS A total of 2062 adolescents completed questionnaires (age 14.4 +/- 2.3 yr; diabetes duration 6.1 +/- 3.5 yr). Mean HbA 1c = 8.2 +/- 1.4% with significant differences between centres (F = 12.3; p < 0.001) range from 7.4 to 9.1%. There was a significant correlation between parent (r = 0.20) and adolescent (r = 0.21) reports of their perceived ideal HbA1c and their actual HbA1c result (p < 0.001), and a stronger association between parents' (r = 0.39) and adolescents' (r = 0.4) reports of the HbA1c they would be happy with and their actual HbA1c result. There were significant differences between centres on parent and adolescent reports of ideal and happy with HbA1c (8.1 < F > 17.4;p < 0.001). A lower target HbA1c and greater consistency between members of teams within centres were associated with lower centre HbA1c (F = 16.0; df = 15; p < 0.001). CONCLUSIONS Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in metabolic outcomes between centres.
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Affiliation(s)
- P G F Swift
- Children's Hospital, Leicester Royal Infirmary, UK.
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Wolber T, Ward D. Implementation of a diabetes nurse case management program in a primary care clinic: a process evaluation. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-9824.2010.01051.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Compeán-Ortiz LG, Gallegos EC, Gonzalez-Gonzalez JG, Gomez-Meza MV, Therrien B, Salazar BC. Cognitive performance associated with self-care activities in Mexican adults with type 2 diabetes. DIABETES EDUCATOR 2010; 36:268-75. [PMID: 20179249 DOI: 10.1177/0145721710361783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of memory-learning on self-care activities in adults with type 2 diabetes moderated by previous education/understanding in diabetes and to explore the explicative capacity of age, gender, schooling, diabetes duration, and glycemic control in memory-learning. METHODS A descriptive correlational study was conducted in a randomized sample of 105 Mexican adult patients with type 2 diabetes at a community-based outpatient clinic. Evaluation measures included the Wechsler Memory Scale for memory-learning; 2 questionnaires for self-care activities and previous education/understanding in diabetes, respectively; and glycosylated hemoglobin for glycemic control. Multiple linear regression analysis was used to examine the effect of memory-learning on self-care activities and the moderator capacity of previous education/understanding on diabetes. Multivariate analysis was used to identify the capacity of age, schooling, diabetes duration, and glycemic control in memory-learning types. RESULTS A significant positive effect of memory-learning on self-care activities was found. Education/understanding in diabetes moderated the relationship between immediate and delayed memory-learning and self-care in glucose monitoring and diet. Gender, schooling, and the gender-glycemic control interaction explained memory-learning performance. CONCLUSIONS Immediate and delayed verbal and visual memory-learning were important for the patient to carry out self-care activities, and this relationship can be moderated by previous education/understanding in diabetes. These findings suggest potential benefits in emphasizing cognitive strategies to promote relearning of self-care behaviors in persons who live with diabetes.
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Affiliation(s)
- Lidia G Compeán-Ortiz
- The Universidad Autonoma de Tamaulipas School of Nursing, Tampico, Tamulipas, Mexico (Dr Compeán-Ortiz)
| | - Esther C Gallegos
- Universidad Autonoma de Nuevo Leon (UANL) School of Nursing, Doctoral Program Department, Monterrey, Nuevo Leon, Mexico (Dr Gallegos)
| | - José G Gonzalez-Gonzalez
- UANL School of Medicine, “Dr. José Eleuterio Gonzalez” University Hospital, Monterrey, Nuevo Leon, Mexico (Dr Gonzalez-Gonzalez)
| | - Marco V Gomez-Meza
- UANL School of Economics, Statistics Center, Monterrey, Nuevo Leon, Mexico (Dr Gomez-Meza)
| | - Barbara Therrien
- University of Michigan School of Nursing, Center for Enhancement and Restoration of Cognitive Function, Ann Arbor, Michigan (Dr Therrien)
| | - Bertha C Salazar
- UANL School of Nursing, Associate Dean of Research, Monterrey, Nuevo Leon, Mexico (Dr Salazar)
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17
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Edwall LL, Danielson E, Ohrn I. The meaning of a consultation with the diabetes nurse specialist. Scand J Caring Sci 2009; 24:341-8. [PMID: 20030773 DOI: 10.1111/j.1471-6712.2009.00726.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate the essential meaning of a consultation between diabetes nurse specialists and patients to gain a deeper understanding of the patients' experiences. METHODS Twenty patients with type 2 diabetes were interviewed about their experience of a consultation at an annual check-up with the diabetes nurse specialist. A phenomenological hermeneutic method was used in the analysis and interpretation of the text. RESULTS The patient's experience of a consultation was interpreted as manifestation of hold on the disease control. This means a safeguard to continue daily life shown in the four themes being controlled, feeling exposed, feeling comfortable, and feeling prepared. CONCLUSION The patients' experiences of a consultation with the diabetes nurse specialist became the basis for a health maintenance process in dealing with critical health-disease aspects. IMPLICATIONS TO PRACTICE: In a consultation, professionals have to take into account the potential emotional turbulence that disease progression can mean to a patient. Diabetes care implies patient dependence on support to avoid a potential self-management insufficiency and call attention to professionals' time for listening to patients' perceptions.
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Affiliation(s)
- Lise-Lotte Edwall
- The Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Göteborg, Sweden.
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18
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Affiliation(s)
- Peter G F Swift
- Childrens Hospital, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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Vincent D. Culturally tailored education to promote lifestyle change in Mexican Americans with type 2 diabetes. ACTA ACUST UNITED AC 2009; 21:520-7. [DOI: 10.1111/j.1745-7599.2009.00439.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Albisser AM, Alejandro R, Sperlich M, Ricordi C. Prescription checking device promises to resolve intractable hypoglycemia. J Diabetes Sci Technol 2009; 3:524-32. [PMID: 20144291 PMCID: PMC2769868 DOI: 10.1177/193229680900300317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Satisfactory glycemic control, meeting American Diabetes Association recommendations, is often accompanied by unsatisfactory hypoglycemia. The converse is also true. We hypothesize that this diabetes treatment dilemma may be resolved by repeated, objective, prescription checks. To do this, a new, two-part device has been developed. It includes a personal diabetes database for the patient and a built-in diabetes prescription checker for the provider. Its goals are to enhance diabetes education and improve patient care. RESEARCH DESIGN AND METHODS The device includes a database and supporting software, all contained in a standard USB flash drive. Using the medical prescription, body weight, and recent self-monitored blood glucose (SMBG) data, prescription checks can be done at any time. To demonstrate the device's capabilities, an observational study was performed using data from 11 patients with type 1 diabetes mellitus, on intensified therapy, with a mean glycated hemoglobin A1c <7%, and who all suffered intractable hypoglycemia. Patients had performed SMBG contours on successive days at monthly intervals. Each contour included pre- and postmeal as well as bedtime measurements. The replicated contours were used to predict the patient's glycemic profile each month. Applying a built-in simulator to each profile, changes in the prescription were explored that were consistent with reducing the recalcitrant hypoglycemia. RESULTS A total of 110 glycemic profiles containing 822 profile points were explored. Of these profile points, 351 (43%) showed risks of hypoglycemia, whereas 385 (47%) fell outside desired ranges. With the simulated changes in the prescription, the predicted risks of hypoglycemia were reduced 2.5-fold with insignificant increases predicted in hemoglobin A1c levels of +0.6 +/- 0.9%. CONCLUSIONS A novel support tool for diabetes promises to resolve the diabetes treatment dilemma. Supporting the patient, it improves self-management. Supporting the provider, it reviews the medical prescription in light of objective outcomes and formalizes interventions for maximum safety and efficacy.
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Affiliation(s)
- A Michael Albisser
- Diabetes Control and Complications Treatment Initiative, Hollywood Beach, FL 33019, USA.
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21
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Albisser AM, Alejandro R, Sperlich M, Ricordi C. Closing the circle of care with new firmware for diabetes: MyDiaBase+RxChecker. J Diabetes Sci Technol 2009; 3:619-23. [PMID: 20144302 PMCID: PMC2769866 DOI: 10.1177/193229680900300328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Satisfactory glycemic control, meeting American Diabetes Association recommendations, is difficult to achieve. Technologically, this is most likely because the circle of care is incomplete. Many have suggested that the introduction of information technology may remedy the situation. However, previous attempts have not succeeded. Recognizing this, we evolved firmware that supports and links both the patient at home and their care providers in the clinic. FIRMWARE DESIGN AND METHODS The device includes software and a database, all contained in a standard USB flash drive. At home, patients use the database portion of the device (MyDiaBase). It fully complements their diabetes education while capturing pertinent self-management information by tracking self-monitored blood glucose data, body weight, medication dosing, physical activity, diet, lifestyle, and stress. In the clinic, providers use the RxChecker program to perform prescription checks that are based on their patients' outcomes data, thereby effectively closing the circle of care.
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Affiliation(s)
- A Michael Albisser
- Diabetes Control and Complications Treatment Initiative, Hollywood Beach, FL 33019, USA.
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Tschiedel B, Cé GV, Geremia C, Mondadori P, Speggiorin S, Puñales MKC. [Establishment of a collaborative work team management for type 1 diabetes mellitus patient]. ACTA ACUST UNITED AC 2009; 52:219-32. [PMID: 18438532 DOI: 10.1590/s0004-27302008000200009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/20/2007] [Indexed: 11/22/2022]
Abstract
This article will provide the necessary information to establish a childhood and adolescence management center that would promote the integration and coordination of interdisciplinary members as healthcare teams. It will also show how Instituto da Criança com Diabetes from Rio Grande do Sul (ICD) was built, structured and how it works. The aim of this program is to decrease the frequency of hospitalization in acute cases, to decrease chronic complications and to qualify human resources. So far 1315 outpatients and day-care hospital patients, mostly type 1 diabetes, have been seeing free of charge in Public Health Service (PHS), in a partnership with Grupo Hospitalar Conceição (GHC) and the Ministry of Health. Among other activities an educational program (consisting of 45-minute daily classes) is given to the patient and his family. From 2004 to 2007 it could be seen a decrease from 7,5% to 2,7% in the diabetes related hospitalization concerning these patients. Clinical guidelines followed by the interdisciplinary ICD team will also be presented in this essay.
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Affiliation(s)
- Balduino Tschiedel
- Instituto da Criança com Diabetes, Hospital da Criança Conceição, Porto Alegre, RS, Brasil.
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Magwood GS, Zapka J, Jenkins C. A review of systematic reviews evaluating diabetes interventions: focus on quality of life and disparities. DIABETES EDUCATOR 2008; 34:242-65. [PMID: 18375775 DOI: 10.1177/0145721708316551] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This article reviews the literature on definitions and issues related to measurement of quality of life in people with diabetes and summarizes reviews of evidence of intervention studies, with a particular focus on interventions targeted for underserved and minority populations. METHODS An integrative literature review of reviews was conducted on adult diabetes interventions and outcomes. Five electronic databases were searched. Eligible publications were those published between 1999 and 2006 that described outcome measures. Twelve review articles are included. RESULTS Review studies were heterogeneous in terms of intervention type, content, participants, setting, and outcome measures. Interventions used variable operational definitions and frequently lacked adequate description; therefore, comparisons of findings proved difficult. A clinical outcome, A1C, was the most frequently assessed, with little inclusion of quality-of-life measures. Several reviews and independent studies did not explicitly consider interventions aimed at the underserved. When quality of life was considered, measures and operational definition of domains were limited. CONCLUSIONS Understanding the relationship between interventions and resulting outcomes, particularly quality of life, will require attention to operational definitions and better conceptual models. There is an evidence base emerging about important characteristics of effective intervention programs. This evidence base can guide public health and clinical program planners to better understand and make prudent decisions about assessment, planning, implementation, and evaluation of interventions for people with complex chronic illnesses such as diabetes.
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Affiliation(s)
- Gayenell S Magwood
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ)
| | - Jane Zapka
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ),The Department of Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston (JZ)
| | - Carolyn Jenkins
- The College of Nursing, Medical University of South Carolina, Charleston (GSM, JZ, CJ)
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Wysocki T, Iannotti R, Weissberg-Benchell J, Laffel L, Hood K, Anderson B, Chen R. Diabetes problem solving by youths with type 1 diabetes and their caregivers: measurement, validation, and longitudinal associations with glycemic control. J Pediatr Psychol 2008; 33:875-84. [PMID: 18346973 DOI: 10.1093/jpepsy/jsn024] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This article introduces a new measure of problem-solving skills of youths with type 1 diabetes (T1DM) and adult caregivers in correcting glycemic fluctuations. METHODS The Diabetes Problem Solving Interview (DPSI), a structured interview, was validated during a pilot study of a behavioral intervention. DPSI data and measures of diabetes management were obtained at baseline from 114 youths (ages 9-14.5) and 109 caregivers. Glycosylated hemoglobin (HbA(1c)) was measured quarterly over 9 months. RESULTS Results confirmed the psychometric adequacy of the DPSI. For caregivers, but not youths, low DPSI scores (indicating poor problem-solving skills) were significantly associated with worse HbA(1c) over 9 months. CONCLUSIONS The DPSI has clinical and research utility as a measure of diabetes problem-solving skills. Identification and targeted remediation of caregivers' deficient diabetes problem-solving skills or promotion of youths' utilization of these skills could possibly enhance glycemic control in youths with T1DM.
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Affiliation(s)
- Tim Wysocki
- Center for Pediatric Psychology Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207-8426, USA.
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25
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Edwall LL, Hellström AL, Öhrn I, Danielson E. The lived experience of the diabetes nurse specialist regular check-ups, as narrated by patients with type 2 diabetes. J Clin Nurs 2008; 17:772-81. [DOI: 10.1111/j.1365-2702.2007.02015.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Albisser AM, Wright CE, Sakkal S. Averting iatrogenic hypoglycemia through glucose prediction in clinical practice: progress towards a new procedure in diabetes. Diabetes Res Clin Pract 2007; 76:207-14. [PMID: 17023087 DOI: 10.1016/j.diabres.2006.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Accepted: 09/04/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypoglycemia is a risk factor common to all insulin therapy. The hypothesis is that efforts to reduce or prevent this adverse side effect may fail because providers generally lack the resources to predict not only future blood glucose levels but also future risks of hypoglycemia. This lack has been remedied. A controlled study was undertaken to test the hypothesis. METHODS Twenty-two insulin dependent subjects suffering more than one (1) episode/week of hypoglycemia with similar insulin regimens, similar diabetes education and similar self-management training participated in this study. For all subjects, a remote monitoring resource (registry and database) was used to capture daily SMBG and afford a return path for provider interventions and decision support. Identical telemedical methods were used which differed only for the provider either by the presence (prediction group) or by the absence (control group) of an on-screen, visual display of predicted glycemia and predicted risks of hypoglycemia. The study lasted 2 months. RESULTS Over an average of 41 days from baseline to follow up and while using the glycemic prediction resource, providers intervened more effectively in the prediction group reducing rates of hypoglycemia nine-fold (P<0.0001) and insulin therapy by just -9 U/day (P<0.01). Mean pre-meal glycemia was not compromised. Over 61 days from baseline to final follow up but without glycemic predictions in the control group, providers' interventions were less effective and resulted in no net changes in rates of hypoglycemia, daily insulin therapy, or mean pre-meal glycemia. CONCLUSIONS Given knowledge of future glycemia and future risks of hypoglycemia, providers in clinical practice can now avert iatrogenic hypoglycemia in less than 2 months. A shared diabetes data center furnishing remote data capture and decision support is fundamental to the implementation of this as a new clinical procedure in diabetes.
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Affiliation(s)
- A M Albisser
- Shared Diabetes Data Center, Hollywood, FL 33019, USA.
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27
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Affiliation(s)
- Peter G F Swift
- Childrens Hospital, Leicester Royal Infirmary, Leicester, UK.
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28
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Ko SH, Song KH, Kim SR, Lee JM, Kim JS, Shin JH, Cho YK, Park YM, Jeong JH, Yoon KH, Cha BY, Son HY, Ahn YB. Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Diabet Med 2007; 24:55-62. [PMID: 17227325 DOI: 10.1111/j.1464-5491.2007.02013.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Patient education is a very important part of diabetes care. However, until now, little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes (SIDEP) for people with Type 2 diabetes mellitus. METHODS People with Type 2 diabetes (n = 547) hospitalized from December 1999 to December 2000 were randomly assigned to two groups. Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education. After discharge, all patients were monitored regularly. Laboratory data were obtained, and adherence to self-care behaviour was determined on a five-point scale by questionnaires completed annually. RESULTS Of the patients who completed the SIDEP, 160 (73.1%) were followed up for more than 4 years. The mean HbA(1c) (7.9 +/- 1.2 vs. 8.7 +/- 1.6%; P < 0.05) and the frequency of hospitalization related to diabetes per patient per year (0.3 +/- 0.6 vs. 0.8 +/- 0.9; P < 0.05) was significantly lower in the SIDEP group than in the control group. The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years (P < 0.05). People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c) at follow-up. CONCLUSIONS A well-designed, intensive patient education programme is necessary for people with diabetes. However, regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control, especially in insulin-treated patients.
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Affiliation(s)
- S-H Ko
- Department of Inteernal Medicine, The Catholic University of Korea, Seoul, South Korea
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Skinner TC, Carey ME, Cradock S, Daly H, Davies MJ, Doherty Y, Heller S, Khunti K, Oliver L. Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND): process modelling of pilot study. PATIENT EDUCATION AND COUNSELING 2006; 64:369-77. [PMID: 17011154 DOI: 10.1016/j.pec.2006.04.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2005] [Revised: 03/27/2006] [Accepted: 04/20/2006] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To determine the effects of a structured education program on illness beliefs, quality of life and physical activity in people newly diagnosed with Type 2 diabetes. METHODS Individuals attending a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) program in 12 Primary Care Trusts completed questionnaire booklets assessing illness beliefs and quality of life at baseline and 3-month follow-up, metabolic control being assessed through assay of HbA1c. RESULTS Two hundred and thirty-six individuals attended the structured self-management education sessions, with 97% and 64% completing baseline and 3-month follow-up questionnaires. At 3 months, individuals were more likely to: understand their diabetes; agree it is a chronic illness; agree it is a serious condition, and that they can affect its course. Individuals achieving a greater reduction in HbA1c over the first 3 months were more likely to agree they could control their diabetes at 3 months (r=0.24; p=0.05), and less likely to agree that diabetes would have a major impact on their day to day life (r=0.35; p=0.006). CONCLUSION Pilot data indicate the DESMOND program for individuals newly diagnosed with Type 2 diabetes changes key illness beliefs and that these changes predict quality of life and metabolic control at 3-month follow-up. PRACTICE IMPLICATIONS Newly diagnosed individuals are open to attending self-management programs and, if the program is theoretically driven, can successfully engage with the true, serious nature of diabetes.
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MESH Headings
- Activities of Daily Living
- Attitude to Health
- Choice Behavior
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Female
- Follow-Up Studies
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Health Services Research/organization & administration
- Humans
- Informed Consent
- Male
- Middle Aged
- Models, Educational
- Models, Organizational
- Models, Psychological
- Outcome and Process Assessment, Health Care
- Patient Education as Topic/organization & administration
- Patient-Centered Care/organization & administration
- Pilot Projects
- Power, Psychological
- Program Evaluation
- Quality of Life/psychology
- Research Design
- Self Care/methods
- Self Care/psychology
- Social Support
- Surveys and Questionnaires
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Affiliation(s)
- T Chas Skinner
- School of Psychology & School of Medicine, University of Southampton, Southampton, UK.
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Redmond EH, Burnett SM, Johnson MA, Park S, Fischer JG, Johnson T. Improvement in A1C Levels and Diabetes Self-Management Activities Following a Nutrition and Diabetes Education Program in Older Adults. ACTA ACUST UNITED AC 2006; 26:83-102. [PMID: 17890205 DOI: 10.1300/j052v26n01_05] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the effects of a nutrition and diabetes education intervention on improving hemoglobin A1C levels, diabetes self-management activities, and A1C knowledge in congregate meal recipients in senior centers in north Georgia. Participants were a convenience sample and completed a pre-test, an educational intervention, and a post-test (N = 91, mean age = 73 years, 60% Caucasian, and 40% African American). Following the intervention, (1) A1C levels significantly decreased by 0.66 and 1.46% among those with pretest A1C of > 6.5% and > 8%, respectively (P <or= 0.01); (2) compliance significantly increased following a healthful diet, following an eating plan, avoiding high fat foods, spacing carbohydrates, testing blood sugar as recommended by health care provider and inspecting shoes (P <or= 0.05); (3) the number of A1C knowledge questions answered correctly increased from 42% to 65% (P < 0.0001); and (4) decreases in A1C among those with an initial A1C > 6.5% were correlated with increases in physical activity (P <or= 0.05). This nutrition and diabetes intervention improved several aspects of the diabetes self-management activities and A1C knowledge, with concurrent decreases in A1C levels in older adults; however, additional interventions are needed to improve A1C levels, diabetes self-management activities, and A1C awareness in older adults.
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Affiliation(s)
- Elizabeth H Redmond
- The University of Georgia, Department of Foods and Nutrition, Athens, GA 30602, USA
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Dyck LR, Caron A, Aron D. Working on the positive emotional attractor through training in health care. JOURNAL OF MANAGEMENT DEVELOPMENT 2006. [DOI: 10.1108/02621710610678481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Haase R, Russell S. Improving Diabetes Care and Outcomes in a Rural Primary Care Clinic. Jt Comm J Qual Patient Saf 2006; 32:246-52. [PMID: 16761788 DOI: 10.1016/s1553-7250(06)32032-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data have shown that despite the availability of a wide variety of treatment approaches to normalize plasma glucose, the great majority of diabetic patients remain poorly controlled. The goal of a small, rural health care organization that included a critical access hospital and a 25-provider physician group was to improve glycated hemoglobin (A1C) outcomes among patients with Type 2 diabetes and to improve frequency of testing (A1C) levels. IMPLEMENTING THE IMPROVEMENT INITIATIVE: Academic detailing in practice guidelines with algorithms for care and a diabetes self-management education program were the first key activities in the improvement initiative. A variety of performance improvement activities were implemented. A diabetes care flow sheet was used to monitor and report process and outcome measurements. A diabetes registry to enter process and outcome data was introduced; data can be displayed by specific provider, by the organization as a whole, by patients whose A1C is > 7, and by patients who have not had an A1C in the last six months. The diabetes care team includes the patient, the primary care provider who provides medical management, and the diabetes educators (pharmacist and dietitian). RESULTS As of December 2005, hemoglobin A1C levels averaged 6.7 for the 566 patients in the registry. DISCUSSION The greatest barrier to implementing the initiative lies in the challenge of trying to provide chronic care in an acute care medical model.
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McTigue K, Hess R, Bryce CL, Fitzgerald K, Olshansky E, Sacco D, Fischer G. Perception of "healthy" body weight by patients with diabetes. Diabetes Care 2006; 29:695-7. [PMID: 16505529 DOI: 10.2337/diacare.29.03.06.dc05-2459] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Kathleen McTigue
- Center for Research on Health Care, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
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Abstract
OBJECTIVE To promote the role of the diabetes educator as an important team member in conjunction with the patient and other clinicians in optimizing diabetes management. METHODS The goal of the diabetes educator in facilitating changes in patient behavior is reviewed, and current trends and strategies for improvement of outcomes by means of diabetes education are outlined. RESULTS The American Association of Diabetes Educators (AADE) is a multidisciplinary group of healthcare professionals dedicated to the professional growth and development of personnel who are responsible for diabetes education. Diabetes management is best addressed by using a team approach in a patient-centered care environment. Diabetes education encompasses more than the dissemination of information; the goal is to facilitate changes in specific behaviors relating to both therapy and lifestyle that support good diabetes management and improved clinical outcomes. Diabetes educators currently frame their intervention on the basis of the AADE 7 Self-Care Behaviors: (1) healthful eating, (2) being active, (3) monitoring, (4) taking medication, (5) problem-solving, (6) healthful coping, and (7) reducing risks. Diabetes education is underutilized; approximately 60% to 70% of patients with diabetes have not received training in diabetes self-management. Diabetes educators are trained to identify and help overcome barriers to optimal diabetes care. CONCLUSION Individual patients and the overall health-care system will benefit when physicians and other health-care providers collaborate with diabetes educators to ensure that patients receive the information, training, and support needed to facilitate effective diabetes self-management.
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Espinet LM, Osmick MJ, Ahmed T, Villagra VG. A Cohort Study of the Impact of a National Disease Management Program on HEDIS Diabetes Outcomes. ACTA ACUST UNITED AC 2005; 8:86-92. [PMID: 15815157 DOI: 10.1089/dis.2005.8.86] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diabetes disease management programs (DDMP) are proliferating, but their overall impact in improving quality of care using Health Employer Data and Information Set (HEDIS) quality metrics has not been well studied. Furthermore, DDMPs are usually ongoing, but the incremental benefits of continuing the program beyond the initial patient educational intervention have not been rigorously tested. This study evaluates the impact of length of DDMP participation on diabetes-related HEDIS 2002 quality indicators across 20 health plans. Results are stratified by duration of DDMP participation into three levels, "full participants" (6-12 months duration), "partial participants" (<6 months duration) and "non-participants" (0 months duration). The overall national compliance rate across all six combined HEDIS quality measures was 65.6% among full-participants (FP), 58.4% among partial-participants (PP) and 57.0% among non-participants (NP). This study demonstrates that participants in a comprehensive DDMP fair better than non-participants and that those with sustained participation (>6 months) benefit the most.
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Affiliation(s)
- Lawrence M Espinet
- Health Data Analysis, Medical Analysis and Customer Reporting, Bloomfield, Connecticut 06002, USA.
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