Assessing the impact of an outpatient education program for patients with gestational diabetes

Effect of ambulatory versus hospital treatment for gestational diabetes or hyperglycemia on infant mortality rates: a systematic review

CONTEXT AND OBJECTIVE

Pregnancies complicated by diabetes are associated with increased neonatal and maternal complications. The most serious maternal complication is the risk of developing type 2 diabetes, 10-12 years after the delivery. For rigorous control over blood glucose, pregnant women are treated through ambulatory management or hospitalization. The aim of this study was to evaluate the effectiveness of ambulatory management versus hospitalization in pregnancies complicated by diabetes or hyperglycemia.

DESIGN AND SETTING

Systematic review conducted in a public university hospital.

METHODS

A systematic review of the literature was performed and the main electronic databases were searched. The date of the most recent search was September 4, 2011. Two authors independently selected relevant clinical trials, assessed their methodological quality and extracted data.

RESULTS

Only three studies were selected, with small sample sizes. There was no statistically significance different between ambulatory management and hospitalization, regarding mortality in any of the subcategories analyzed: perinatal and neonatal deaths (relative risk [RR] 0.65; 95% confidential interval [CI]: 0.11 to 3.84; P = 0.63); neonatal deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43); and infant deaths (RR 0.29; 95% CI: 0.01 to 6.07; P = 0.43).

CONCLUSIONS

This review, based on studies with high or moderate risk of bias, showed that there was no statistically significant difference between ambulatory management and hospital care, regarding reduction of mortality rates in pregnancies complicated by diabetes or hyperglycemia. It also suggested that there is a need for further randomized controlled trials on this issue.

A community-based parish nurse intervention program for Mexican American women with gestational diabetes

OBJECTIVE

To examine the effects of a Parish Nurse Intervention Program (PNIP) on maternal health behaviors, glycemic control, and neonatal outcomes among Mexican American women with gestational diabetes.

DESIGN

A randomized controlled trial comparing care as usual (CAU) with a supplementary 1-hour education session for diabetes education reinforcement by a Parish Nurse.

SETTING

An outpatient treatment clinic for gestational diabetes within a 250-bed tertiary care, non-profit hospital with a Parish Nurse partnership.

PARTICIPANTS

One hundred Mexican American women were included in the study with randomization into Parish Nurse Intervention Program (n=49) and care as usual (n=51) groups.

MAIN OUTCOME MEASURES

The Health Promoting Lifestyle Profile II (HPLP II) and two measures of glycemic control pre- and post-intervention, as well as newborn size, and days of maternal and neonatal hospitalization.

RESULTS

Outcomes indicate significantly improved Health Promoting Lifestyle Profile II scores in the Parish Nurse Intervention Program group post-intervention compared with the Care As Usual group. No significant differences between groups regarding glycemic control, macrosomia, or days of maternal or neonatal hospitalization were found.

CONCLUSIONS

A Parish Nurse Intervention Program for pregnant women of Mexican descent with gestational diabetes is effective in leading to improved self-reported health promoting behaviors.

Nurse-based management in patients with gestational diabetes

OBJECTIVE

To compare the rate of insulin treatment and perinatal outcome in women with gestational diabetes mellitus (GDM) under endocrinologist-based versus diabetes nurse-based metabolic management.

RESEARCH DESIGN AND METHODS

In a retrospective analysis, maternal characteristics, rate of insulin treatment, and perinatal outcome of patients with GDM delivering between 1 January 1995 and 30 June 1997 (n = 244) receiving endocrinologist-based care were compared with those delivering between 1 July 1997 and 31 December 1999 (n = 283) who received diabetes nurse-based care. The diabetes nurse's role was similar to that of an advanced practice nurse in the U.S. There were no changes in the metabolic goals and instruments or in obstetric and neonatal management. Quantitative data were compared with the Mann-Whitney U test and categorical data, with Fisher's exact test.

RESULTS

Maternal characteristics (age, BMI, family history of diabetes, prior glucose intolerance, gestational age, and blood glucose at diagnosis of GDM) did not differ between groups treated during the two periods. Rates of insulin treatment and perinatal outcome (hypertension, preterm delivery, cesarean section, low Apgar score, macrosomia, small- and large-for-gestational-age newborns, obstetric trauma, major malformations, hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and mortality) were also similar in both groups.

CONCLUSIONS

Comparison of periods of endocrinologist-based and diabetes nurse-based metabolic management of women with GDM showed no differences in the rate of insulin treatment and perinatal outcome. This supports a more active role of nurses in the management of women with GDM.

Diabetes patient education research: an integrative literature review

PURPOSE

The purpose of this study is to summarize the accumulated state of knowledge in the area of diabetes patient education research and highlight important issues that research has left unanswered.

METHODS

An integrative literature review was conducted on the topic of diabetes patient education between the years 1985 and 1998. Keywords used in the computerized search were diabetes mellitus, patient education, health education, research, and behavior change. The databases searched were MEDLINE, CINAHL, HealthSTAR, EMBASE, and CHID-HE. A total of 78 papers were reviewed.

RESULTS

Most studies lacked a theoretical framework and the majority of studies were conducted in an outpatient setting. HbA1c was the most frequently employed outcome measure, with little, if any, description of the interventions.

CONCLUSIONS

Much has been learned in terms of the effectiveness of diabetes education on improving knowledge. However, other topic areas and outcomes need further exploration.

Interventions to promote diabetes self-management: state of the science

PURPOSE

The purpose of this paper is to review the diabetes education literature that has emerged over the past 20 years to determine what we currently know about diabetes self-management interventions and their effectiveness in producing improved health outcomes.

METHODS

Findings of studies that were reported prior to 1990 were compared with findings of studies that have been conducted since 1990 to determine what recent changes and patterns in diabetes self-management education have occurred. Future directions in diabetes self-management research and practice were projected from these findings.

RESULTS

Most studies lacked adequate descriptions of the interventions tested, which precludes replication or application of the most effective strategies to clinical practice. Trends in interventions have evolved from education only to education plus behavioral models, with more attention given to interventions specifically for minority populations. The interventions that have been designed and tested seem to be longer, with more emphasis on simple, practical approaches to diabetes self-management.

CONCLUSIONS

The literature supports the effectiveness of diabetes education and behavioral interventions in improving psychosocial and health outcomes. The question of how to best achieve these improved outcomes continues to need further exploration.