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Caduff A, Ben Ishai P, Feldman Y. Continuous noninvasive glucose monitoring; water as a relevant marker of glucose uptake in vivo. Biophys Rev 2019; 11:1017-1035. [PMID: 31741172 DOI: 10.1007/s12551-019-00601-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/13/2019] [Indexed: 01/22/2023] Open
Abstract
With diabetes set to become the number 3 killer in the Western hemisphere and proportionally growing in other parts of the world, the subject of noninvasive monitoring of glucose dynamics in blood remains a "hot" topic, with the involvement of many groups worldwide. There is a plethora of techniques involved in this academic push, but the so-called multisensor system with an impedance-based core seems to feature increasingly strongly. However, the symmetrical structure of the glucose molecule and its shielding by the smaller dipoles of water would suggest that this option should be less enticing. Yet there is enough phenomenological evidence to suggest that impedance-based methods are truly sensitive to the biophysical effects of glucose variations in the blood. We have been trying to answer this very fundamental conundrum: "Why is impedance or dielectric spectroscopy sensitive to glucose concentration changes in the blood and why can this be done over a very broad frequency band, including microwaves?" The vistas for medical diagnostics are very enticing. There have been a significant number of papers published that look seriously at this problem. In this review, we want to summarize this body of research and the underlying mechanisms and propose a perspective toward utilizing the phenomena. It is our impression that the current world view on the dielectric response of glucose in solution, as outlined below, will support the further evolution and implementation toward practical noninvasive glucose monitoring solutions.
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Affiliation(s)
- Andreas Caduff
- Applied Physics Department and the Center for Electromagnetic Research and Characterization, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel
| | - Paul Ben Ishai
- Department of Physics, Ariel University, 40700, Ariel, Israel
| | - Yuri Feldman
- Applied Physics Department and the Center for Electromagnetic Research and Characterization, The Hebrew University of Jerusalem, 91904, Jerusalem, Israel.
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Świątoniowska N, Sarzyńska K, Szymańska-Chabowska A, Jankowska-Polańska B. The role of education in type 2 diabetes treatment. Diabetes Res Clin Pract 2019; 151:237-246. [PMID: 31063855 DOI: 10.1016/j.diabres.2019.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus is a major and growing medical problem, affecting patients of all ages worldwide. Diabetes education is an important component of diabetes treatment. The goals of diabetes education include not only providing knowledge and skills, but also changing the patient's behavior, increasing their motivation to comply with therapeutic recommendations, improving their quality of life, establishing a partnership within the treatment process, preparing the patient for self-care, increasing their awareness of cardiovascular risk factors, and increasing their psychological resilience. The education process is affected by a number of factors, primarily the patient's psychological and socio-economic characteristics, as well as educator-related variables. Benefits of diabetes education are mainly observed in terms of patient self-care and metabolic control of diabetes.
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Affiliation(s)
- Natalia Świątoniowska
- Division of Nursing in Internal Medicine, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland.
| | - Kathie Sarzyńska
- Student Research Club at the Division of Nursing in Internal Medicine, Department of Clinical Nursing, Faculty of Health Science, Wrocław Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland.
| | - Anna Szymańska-Chabowska
- Dept of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, 213 Borowska Street, 50-556 Wroclaw, Poland.
| | - Beata Jankowska-Polańska
- Division of Nursing in Internal Medicine, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland.
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Alotaibi A, Gholizadeh L, Al-Ganmi AHA, Perry L. Factors influencing nurses’ knowledge acquisition of diabetes care and its management: A qualitative study. J Clin Nurs 2018; 27:4340-4352. [DOI: 10.1111/jocn.14544] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Abdulellah Alotaibi
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- Faculty of Applied Health Science; Shaqra University; Dawami Saudi Arabia
| | - Leila Gholizadeh
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
| | - Ali Hussein Alek Al-Ganmi
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- College of Nursing; University of Baghdad; Baghdad Iraq
| | - Lin Perry
- Faculty of Health; University of Technology Sydney (UTS); Broadway NSW Australia
- South Eastern Sydney Local Health District; Sydney NSW Australia
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Egede LE, Williams JS, Voronca DC, Gebregziabher M, Lynch CP. Telephone-Delivered Behavioral Skills Intervention for African American Adults with Type 2 Diabetes: A Randomized Controlled Trial. J Gen Intern Med 2017; 32:775-782. [PMID: 28337686 PMCID: PMC5481234 DOI: 10.1007/s11606-017-4023-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes disproportionately affects African Americans and is associated with poorer outcomes. Self-management is important for glycemic control; however, evidence in African Americans is limited. OBJECTIVE To assess the efficacy of a combined telephone-delivered education and behavioral skills intervention (TBSI) in reducing hemoglobin A1c (HbA1c) levels in African Americans with type 2 diabetes, using a factorial design. DESIGN This is a four-year randomized clinical trial, using a 2 x 2 factorial design.: Participants: African American adults ≥18 years) with poorly controlled type 2 diabetes (HbA1c ≥9%) were randomly assigned to one of four groups: 1) knowledge only, 2) skills only, 3) combined knowledge and skills (TBSI), or 4) control group. INTERVENTION All participants received 12 telephone-delivered 30-min intervention sessions specific to their assigned group. Participants were assessed at baseline and 3, 6, and 12 months. MAIN MEASURE The primary outcome was HbA1c at 12 months post-randomization in the intent-to-treat (ITT) population. KEY RESULTS Two hundred fifty-five participants were randomly assigned to the four groups. Based on the ITT population after multiple imputation, the analysis of covariance with baseline HbA1c as the covariate showed that HbA1c at 12 months for the intervention groups did not differ significantly from that of the control group (knowledge: 0.49, p = 0.123; skills: 0.23, p = 0.456; combined: 0.48, p = 0.105). Absolute change from baseline at 12 months for all treatment arms was 0.6. Longitudinal mixed effects analysis showed that, on average, there was a significant decline in HbA1c over time for all treatment groups (-0.07, p < 0.001). However, the rates of decline for the intervention groups were not significantly different from that of the control group (knowledge: 0.06, p = 0.052; skills: 0.02, p = 0.448; combined: 0.05, p = 0.062). Results from per-protocol populations were similar. CONCLUSIONS For African Americans with poorly controlled type 2 diabetes, combined education and skills training did not achieve greater reductions in glycemic control (i.e., HbA1c levels) at 12 months compared to the control group, education alone, or skills training alone. This trial is registered with ClinicalTrials.gov, identifier no. NCT00929838.
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Affiliation(s)
- Leonard E Egede
- Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA. .,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA. .,Division of General Internal Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Joni S Williams
- Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.,Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of General Internal Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Mulugeta Gebregziabher
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cheryl P Lynch
- Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC, USA.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Martinez NC, Tripp-Reimer T. Diabetes Nurse Educators' Prioritized Elder Foot Care Behaviors. DIABETES EDUCATOR 2016; 31:858-68. [PMID: 16288093 DOI: 10.1177/0145721705282252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to identify diabetes nurse educators' perceptions of the most important foot care behaviors for elderly people to enact in daily care. Methods A structured, open-ended questionnaire was mailed to a regionally stratified random sample of 90 diabetes nurse educators. Subjects were asked to identify and rank order 8 foot care behaviors perceived important for elderly people with diabetes to enact daily. Data were transcribed and coded into categories and domains using descriptive content analysis. Results Forty-seven diabetes nurse educators responded with a total of 346 foot care behaviors perceived important for elders. Twenty-one major foot care behavior content categories were grouped into 4 domains of descending importance: foot/nail care, footwear/shoes, general health, and foot emergencies. Conclusions Diabetes nurse educators generated a range of baseline data for developing a reliable, valid, and patient foot care knowledge outcome measure to support national diabetes patient education and self-management program guidelines.
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Giesler PD, Bjornsen SS, Rahn DA, Smith SA, Montori VM. Cardiovascular Risk Reduction and Diabetes Education: What Are We Telling Our Patients? DIABETES EDUCATOR 2016; 30:994-9. [PMID: 15641620 DOI: 10.1177/014572170403000620] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine the extent to which diabetes education encounters include evidence-based content aimed at reducing the risk of cardiovascular disease. METHODS During a 2-week period in November 2001, 3 certified diabetes educators (CDEs) listed the statements they made while teaching patients. These statements/comments were then assigned to the 7 outcome areas identified by the Diabetes Self-Management Assessment Report Tool (D-SMART). All educational encounters completed during that same month by 21 educators were reviewed for content areas or modules consistent with the American Diabetes Association National Standards. RESULTS Of all statements made by the 3 CDEs, 63% were about glycemic control while only 5% were directly relevant to cardiovascular risk reduction. There were 1043 educational encounters in November 2001, of which only 10% targeted cardiovascular risk. Educators focused most of their educational efforts (62%) on glycemic control. CONCLUSIONS Despite its potential impact and strong evidence base, diabetes education gives little attention to the reduction of cardiovascular risk. Diabetes educators should emphasize interventions that are most likely to be effective in reducing cardiovascular morbidity and mortality in patients with diabetes.
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Affiliation(s)
- Paula D Giesler
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Susan S Bjornsen
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Diedre A Rahn
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Steven A Smith
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Victor M Montori
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
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Lindblad AJ, Cleave-Hogg D. Strategies for Teaching Self-Care with Type 2 Diabetes: Focus on Adult Development Theory. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350613900411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Adrienne J. Lindblad
- Adrienne Lindblad is the Acting Regional Pharmacy Clinical Coordinator with the David Thompson Health Region, in Red Deer, Alberta, and a PharmD candidate at the University of Toronto. Doreen Cleave-Hogg is the Educational Science Researcher, Centre for Research in Education, Faculty of Medicine, University of Toronto; Assistant Professor, Faculty of Pharmacy, University of Toronto; and Associate Director of Medical Education, Department of Anesthesiology, Canadian Simulation Centre, Sunnybrook Health
| | - Doreen Cleave-Hogg
- Adrienne Lindblad is the Acting Regional Pharmacy Clinical Coordinator with the David Thompson Health Region, in Red Deer, Alberta, and a PharmD candidate at the University of Toronto. Doreen Cleave-Hogg is the Educational Science Researcher, Centre for Research in Education, Faculty of Medicine, University of Toronto; Assistant Professor, Faculty of Pharmacy, University of Toronto; and Associate Director of Medical Education, Department of Anesthesiology, Canadian Simulation Centre, Sunnybrook Health
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Sanjari M, Peyrovi H, Mehrdad N. Managing children with diabetes within the family: Entering into the Diabetes Orbit. J Diabetes Metab Disord 2016; 15:7. [PMID: 26998445 PMCID: PMC4797217 DOI: 10.1186/s40200-016-0228-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/06/2016] [Indexed: 02/07/2023]
Abstract
Background Diabetes is the disease of family and parents of children with diabetes face different problems which concerns meeting the developmental needs of children and daily control of children with diabetes. This article aims to explain how to manage diabetes around the child’s life within the family. Methods In this qualitative study, data was collected through semi-structured interview technique and was analyzed using Grounded Theory approach. The process of data collection was carried out by purposeful sampling. The participants included 13 individuals from nine families (11 parents and two children with diabetes). The research environment was health centers in Iran providing care to the families of children with diabetes. Data analysis was performed using Corbin and Strauss approach. Data was analyzed with using MAXQDA software (version 10). Results The core category of “Entering into the Orbit of Diabetes” addresses the story of how to keep track of managing children with diabetes within the family which included Main categories “bitter taste of sugar”, “drawing coordinates of diabetes”, and “taking control of diabetes”. Conclusion The outcome of “enter into the orbit of diabetes” results capturing the control of diabetes. The findings of the present study may play an integral part to help households with practicing appropriate strategies for the management of children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran ; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran ; Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Hogue VW, Lee E. Community Education Program on Oral Antidiabetes Medicines. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2005.tb00319.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Euni Lee
- School of Pharmacy; Howard University; Washington DC
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Krakow D, Feulner-Krakow G. LINDA: the diabetes self-management training programme for people with type 1 or type 2 diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.90] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Repping-Wuts HJWJ, Stikkelbroeck NMML, Noordzij A, Kerstens M, Hermus ARMM. A glucocorticoid education group meeting: an effective strategy for improving self-management to prevent adrenal crisis. Eur J Endocrinol 2013; 169:17-22. [PMID: 23636446 DOI: 10.1530/eje-12-1094] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess self-management in patients receiving glucocorticoid replacement therapy for primary or secondary adrenal failure before and 6 months after a glucocorticoid education group meeting. METHODS All patients with primary or secondary adrenal insufficiency, treated at the Department of Medicine, Division of Endocrinology, were invited by their endocrinologist to participate in a 3-h glucocorticoid education group meeting, consisting of a lecture about the disease and glucocorticoid doses adjustments in case of stress, followed by an instruction on how to inject hydrocortisone i.m. Finally, all participants could practise the i.m. injection and discuss their experience with (imminent) adrenal crises with other patients and the health care providers. Two weeks before the meeting and 6 months after the meeting, patients were asked to fill out a questionnaire about how they would act in six different conditions (e.g. febrile illness or vomiting). RESULTS Of the 405 patients who were invited, 246 patients (61%) participated. At baseline the response by the participants on the questionnaire was 100% (n=246) and at follow-up 74% (n=183). At follow-up, significantly more participants (P≤0.005) gave the correct answers to how to act in different situations (e.g. self-administration of a glucocorticoid injection and phone contact in case of vomiting/diarrhoea without fever). Moreover, the use of self-management tools, such as having a 'medicine passport (travel document with information about disease and medication) (P=0.007) or SOS medallion (P=0.0007)', increased. CONCLUSION A glucocorticoid education group meeting for patients with adrenal failure seems helpful to improve self-management and proper use of stress-related glucocorticoid dose adjustment.
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Affiliation(s)
- Han J W J Repping-Wuts
- Division of Endocrinology, Department of Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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The effects of education with printed material on glycemic control in patients with diabetes type 2 treated with different therapeutic regimens. VOJNOSANIT PREGL 2011; 68:676-83. [PMID: 21991791 DOI: 10.2298/vsp1108676s] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM Diabetes mellitus (DM) is considered to be an epidemic, chronic and progressive disease. The treatment of DM reqiures substantial effort from both the diabetes treatment team and a patient. Patient education is one of the treatment elements. The most efficacious form and content of education has not yet been established. However, every DM education must include introduction to a substantial number of facts about diabetes. The aim of our study was to estimate the levels of DM knowledge and glycemic control in Serbian patients with DM type 2 as well as to estimate the effects of education using printed material on the levels of glycemic control and knowledge about DM. Also, the effects of education on glycemic control and the level of knowledge in differently treated patients were estimated. METHODS The patients with DM type 2 (n = 364), aged 40 to 65 years, from three regional health centers, were randomized for the study. After informed consent, patients filled out the questionnaire, and were checked for HbA1c and fasting blood glucose. Finally, booklet "Healthy lifestyle with diabetes mellitus type 2" was given to them. The same procedure was repeated after 3, 6 and 18 months. RESULTS There was a significant improvement in HbA1c levels after 3 months (8.00 +/- 1.66% vs 9.06 +/- 2.23%, p < 0.01) and after 6 months (7.67 +/- 1.75% vs 9.06 +/- 2.23%, p < 0.01). There was no further improvement in HbA1c levels after 18 months (7.88 +/- 1.46% vs 7.67 +/- 1.75%, p > 0.05). There was a significant improvement in the average test score (percent of correct answers per test sheet) after three monts (64.6% vs 55.6%, p < 0.01). There were no further statistically significant changes in the general level of DM knowledge after 6 months (65.0 +/- 32.5% vs 64.5 +/- 33.7%, p > 0.05) and after 18 months (64.8 +/- 32.7 vs 64.5 +/- 33.7%, p > 0.05). There was a significant diffrence in educational intervention response in DM type 2 patients on different therapeutic regimens. CONCLUSION Education with printed material led to improvement in glycemic control and level of DM knowledge in our patients. Education with printed material may be a useful adjunct to DM treatment and should be structured according to the treatment modality.
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[Blood glucose self-monitoring among patients with diabetes mellitus type 2 in family medicine practice]. MEDICINSKI PREGLED 2009; 62:342-5. [PMID: 19902786 DOI: 10.2298/mpns0908342h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Good knowledge of diabetic patients about their disease is often not related with good glycemic control. The aim of this study was to determine the level of application of acquired knowledge about diabetes in recognizing and resolving hypoglycemic and hyperglycemic conditions in patients who did or did not do blood glucose self-monitoring as well as the impact of self-monitoring on HbA1c during education of patients with diabetes type 2. MATERIAL AND METHODS There were 91 patients with the type 2 diabetes who completed six months education about their disease in four family medicine practices in Tuzla Canton during the period from March to September 2005. The patients who did or did not do self-monitoring with glucometer were interviewed on knowledge about recognizing and resolving hypoglycemia and hyperglycemia by family physician and HbA1c was assessed at the beginning of the education, 3 months after reading the brochure (passive education) and additional 3 months of group (intensive) education. RESULTS Out of 91 interviewed patients, there were 29 who did self-monitoring by glucometer at the beginning of the education, 30 patients during the passive education and 34 after the intensive education. At the beginning of education, regardless of doing self-monitoring, the patients were less able to recognize and resolve hypoglycemia and even less hyperglycemia. At the end of education, their knowledge was better at both recognizing and resolving hypoglycemia (P=0.01) as well as at recognizing (P=0.01) and resolving hyperglycemia (P=0.001). In the patients who did self-monitoring the average value of the HbA1c did not improve significantly (P=0.44) compared to those who did not practice self-monitoring (P=0.10) during education. CONCLUSION Only one third of patients with type 2 diabetes had done self monitoring with glucometer and although their knowledge about hypoglycemia and hyperglycemia was improved during education, these patients did not have improved significant values of the HbA1c compared to patients who had not done self-monitoring.
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Wong AKY, Stewart AGO, Furler JS. Development and validation of the Diabetes Management Orientation Scale (DMOS): assessing culturally related approaches to diabetes self-management. Diabetes Res Clin Pract 2009; 86:24-30. [PMID: 19671482 DOI: 10.1016/j.diabres.2009.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 05/28/2009] [Accepted: 07/14/2009] [Indexed: 11/24/2022]
Abstract
AIMS Self-management behaviours of type 2 diabetes are improved by self-efficacy while the role of culture is not well understood. This study explored cultural individualist and collectivist aspects of self-management and their relationship to diabetes control. METHODS 94 Adults with type 2 diabetes for over 1 year and Chinese spoken as a first language at home recruited through healthcare providers completed the newly developed Diabetes Management Orientation Scale (DMOS), and a validated Diabetes Self-Efficacy Scale (DSES). Exploratory factor analysis and logistic regression was used to examine the factor structure and relationship to glycemic control. RESULTS Three factors were extracted from the DMOS: Individualist, Collectivist, and Balanced Personal Responsibility (BPR) Orientations to self-management. BPR orientation was the only significant psychosocial predictor of glycemic control in this population (odds ratio of 2.85 for having good diabetes control; HbA1c<7.0). Self-efficacy did not predict glycemic control in our sample. CONCLUSIONS Self-management education and clinical care that builds on BPR orientation may be more important than a sole focus on strengthening self-efficacy. The DMOS has external validity and is potentially useful for both practice and research. Future research should explore how BPR orientation is developed, and whether it predicts glycemic control within more individualist cultures.
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Affiliation(s)
- Aaron K Y Wong
- Department of General Practice, The University of Melbourne, 200 Berkeley St, Carlton, Victoria 3053, Australia
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Leak A, Davis ED, Houchin LB, Mabrey M. Diabetes management and self-care education for hospitalized patients with cancer. Clin J Oncol Nurs 2009; 13:205-10. [PMID: 19349267 PMCID: PMC3677070 DOI: 10.1188/09.cjon.205-210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.
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Affiliation(s)
- Ashley Leak
- The Duke University Medical Center, Durham, NC, USA.
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Fonda SJ, McMahon GT, Gomes HE, Hickson S, Conlin PR. Changes in diabetes distress related to participation in an internet-based diabetes care management program and glycemic control. J Diabetes Sci Technol 2009; 3:117-24. [PMID: 20046656 PMCID: PMC2769854 DOI: 10.1177/193229680900300113] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This article investigated how changes in diabetes distress relate to receiving care management through an Internet-based care management (IBCM) program for diabetes and level of participation in this program. Further, it examined the relationship between diabetes distress and changes in glycemic control. METHODS We enrolled patients of the Veterans Affairs Boston Healthcare System with diabetes who had hemoglobin A1c (HbA1c) levels of ≥9.0%. Subjects were randomized to usual care (n=52) or IBCM (n=52) for 1 year. We measured diabetes distress at baseline and quarterly thereafter using the Problem Areas in Diabetes (PAID) questionnaire. Glycemic control was determined by baseline and quarterly HbA1c. For subjects randomized to IBCM, we measured participation by observing frequency and consistency of their usage of the IBCM patient portal over 12 months. Linear mixed models were used to analyze THE data. RESULTS PAID scores declined over time for both treatment groups. Among subjects randomized to IBCM, the decline in PAID scores over time was significant for sustained users of the IBCM patient portal but not for nonusers. Moreover, subjects whose usage of the patient portal was sustained throughout the study had lower PAID scores at baseline. With respect to changes in glycemic control, HbA1c reduced individual differences in PAID scores by 44%; a lower baseline HbA1c was associated with lower baseline PAID scores, and over time, the decrease in HbA1c was associated with further decreases in the PAID score. CONCLUSIONS Participation in IBCM varies by initial diabetes distress, with people with less distress participating more. For people who participate, IBCM further mitigates diabetes distress. There is also a relationship between achievements in glycemic control and subsequent lowering of diabetes distress. Future research should identify how to maximize fit between patient needs and the provisions of IBCM, with the aim of increasing patient engagement in the active management of their health using this care modality. A key to maximizing fit might be first addressing metabolic control aggressively and then using IBCM for sustainment of health.
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McCormack LA, Williams-Piehota PA, Bann CM, Burton J, Kamerow DB, Squire C, Fisher E, Brownson CA, Glasgow RE. Development and validation of an instrument to measure resources and support for chronic illness self-management: a model using diabetes. DIABETES EDUCATOR 2008; 34:707-18. [PMID: 18669813 DOI: 10.1177/0145721708321021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Few comprehensive and practical instruments exist to measure the receipt of self-management support for chronic illness. An instrument was developed to measure resources and support for self-management (RSSM) for the survey component of the evaluation of the Robert Wood Johnson Foundation's Diabetes Initiative. It includes items to measure an ecological range of RSSM. This article describes the development and validation of the instrument, focusing on individuals' reported access to RSSM from providers and from nonclinical, social, and community sources. METHODS Cross-sectional analyses of the second wave of a survey of participants in the Diabetes Initiative (68% response rate, n = 957) were used. RESULTS Confirmatory factor analyses supported grouping the 17 items into 5 subscales, measuring key aspects of RSSM: individualized assessment, collaborative goal setting, enhancing skills, ongoing follow-up and support, and community resources (comparative fit index = 0.97, Tucker-Lewis fit index = 0.99, and root means square error of approximation = 0.06). The overall scale and 5 subscales were internally consistent (Cronbach alpha >or= .70) and were significantly, positively related to diabetes self-management behaviors, supporting their construct validity. CONCLUSIONS This instrument shows promise for measuring RSSM. Although it was developed for diabetes programs, its ecological orientation and link to the broad framework of chronic care suggest broader application.
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Affiliation(s)
- Lauren A McCormack
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | - Pamela A Williams-Piehota
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | - Carla M Bann
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | - Joseph Burton
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | - Douglas B Kamerow
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | - Claudia Squire
- RTI International, Research Triangle Park, North Carolina (Drs McCormack, Williams-Piehota, Bann, and Kamerow, and Mr Burton and Ms Squire)
| | | | - Carol A Brownson
- Washington University School of Medicine, St Louis, Missouri (Ms Brownson)
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Ginde AA, Clark S, Goldstein JN, Camargo CA. Demographic disparities in numeracy among emergency department patients: evidence from two multicenter studies. PATIENT EDUCATION AND COUNSELING 2008; 72:350-356. [PMID: 18462915 DOI: 10.1016/j.pec.2008.03.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 02/22/2008] [Accepted: 03/09/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the prevalence and demographic disparities in limited numeracy among emergency department (ED) patients. METHODS We performed two cross-sectional studies of ED patients with sub-critical illness in 2000-2001 and 2006. We enrolled 959 adult patients from 28 EDs in 17 US states and measured numeracy based on four validated questions. RESULTS Rates of correct responses for individual numeracy questions ranged from 15% to 68%; only 11% of participants answered all questions correctly. Several demographic characteristics were independently associated with frequency of correct answers, including age (OR 0.92 [95% confidence interval (CI), 0.87-0.97] per (upward arrow) 5 years), race/ethnicity (compared to whites: OR 0.35 for blacks [95%CI, 0.20-0.63]; and OR 0.36 for Hispanics [95%CI, 0.19-0.69]), education (OR 4.74 [95%CI, 2.01-11.14] for high school graduates vs. not), health insurance (OR 1.70 [95%CI, 1.06-2.71] for those with private insurance vs. not), and income (OR 1.13 [95%CI, 1.05-1.22] per (upward arrow) $10,000). CONCLUSION We found a higher prevalence of limited numeracy among ED patients compared to the general population. Significant demographic disparities are consistent with previous observations for general health literacy. PRACTICE IMPLICATIONS Greater understanding of the high prevalence of limited numeracy may guide healthcare providers to simplify messages and communicate health information more effectively.
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Affiliation(s)
- Adit A Ginde
- Division of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA.
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Gucciardi E, DeMelo M, Offenheim A, Stewart DE. Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach. BMC Health Serv Res 2008; 8:33. [PMID: 18248673 PMCID: PMC2277391 DOI: 10.1186/1472-6963-8-33] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 02/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs. METHODS We conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization. RESULTS Working full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results. CONCLUSION Reducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians.
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Affiliation(s)
- Enza Gucciardi
- Ryerson University, School of Nutrition, Toronto, Ontario, Canada
- University Health Network, Women's Health Program Toronto, Ontario, Canada
| | - Margaret DeMelo
- University Health Network, Diabetes Education Centre, Toronto, Ontario, Canada
| | - Ana Offenheim
- University Health Network, Diabetes Education Centre, Toronto, Ontario, Canada
| | - Donna E Stewart
- University Health Network, Women's Health Program Toronto, Ontario, Canada
- University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada
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Gucciardi E. A Systematic Review of Attrition from Diabetes Education Services: Strategies to Improve Attrition and Retention Research. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)21011-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gucciardi E, DeMelo M, Offenheim A, Grace SL, Stewart DE. Patient factors associated with attrition from a self-management education programme. J Eval Clin Pract 2007; 13:913-9. [PMID: 18070262 DOI: 10.1111/j.1365-2753.2006.00773.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine utilization patterns of diabetes self-management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC). METHODS A retrospective medical chart review of first time visits (536) to the centre between 1 August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a 1-year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non-use of group education among new patients. RESULTS Almost 50% of new patients withdrew prematurely from recommended DSME services over the 1-year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part-time were associated with attrition from DSME and non-use of group education when compared with middle aged, non-English-speaking, and non-working patients. CONCLUSIONS High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services.
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Affiliation(s)
- Enza Gucciardi
- Ryerson University, School of Nutrition, Toronto, Ontario, Canada.
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Tomkins CC, Mottola MF, Giroux I. Dietary intake, capillary blood glucose, and activity level of activity-restricted, hospitalized, pregnant women in the third trimester: a pilot study. Appl Physiol Nutr Metab 2007; 32:1105-14. [DOI: 10.1139/h07-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Activity restriction in hospital is commonly prescribed by care providers to decrease the incidence of maternal or fetal morbidity in high-risk pregnancies. The purpose of this pilot descriptive study was to collect preliminary data on dietary intake, capillary blood glucose concentrations, and activity level in high-risk, activity-restricted, pregnant women in the third trimester of pregnancy. Dietary food intake records, capillary blood glucose, and daily pedometer step totals were investigated in 20 activity-restricted women over 7 consecutive days in hospital. Subjects were asked to collect hospital meal tickets, as well as record any additional items not provided by the hospital in a dietary log each day. Capillary blood glucose was collected every morning (fasting) as well as 1 h after breakfast (post-prandial) using a glucometer. Subjects wore a pedometer 24 h/d, and recorded step totals 4 times daily in a pedometer log. In the analysis, average energy and macronutrient intakes met dietary reference intake (DRI) recommendations, as did average intakes of all micronutrients, including maternal supplementation. Without supplementation, vitamin E and iron intakes were lower (p < 0.05) than the DRI recommendations. Average fasting (4.6 ± 0.5 mmol/L) and post-prandial (7.1 ± 1.0 mmol/L) blood glucose concentrations in subjects without gestational diabetes (GDM) did not exceed Canadian Diabetes Association cut-off values for screening of GDM. The mean daily step total of 1579 ± 936 was lower than ambulatory third-trimester women (6495 ± 2282 steps; p < 0.001). Results from this pilot study suggest that with maternal supplementation, these activity-restricted, hospitalized, pregnant women were meeting dietary recommendations, and did not have elevated capillary blood glucose. However, given the severity of activity restriction, these women may be at risk for consequences of extreme inactivity.
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Affiliation(s)
- Christy C. Tomkins
- School of Kinesiology, University of Western Ontario, London, ON N6A 5B8
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4
- R. Samuel McLaughlin Foundation Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON N6A 3K7
- Fetal and Newborn Health Program, Lawson Health Research Institute, London, ON N6C 2V5
- Child Health Research Institute, London Health Sciences Centre, London, ON N6A 3K7
| | - Michelle F. Mottola
- School of Kinesiology, University of Western Ontario, London, ON N6A 5B8
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4
- R. Samuel McLaughlin Foundation Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON N6A 3K7
- Fetal and Newborn Health Program, Lawson Health Research Institute, London, ON N6C 2V5
- Child Health Research Institute, London Health Sciences Centre, London, ON N6A 3K7
| | - Isabelle Giroux
- School of Kinesiology, University of Western Ontario, London, ON N6A 5B8
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4
- R. Samuel McLaughlin Foundation Exercise and Pregnancy Laboratory, University of Western Ontario, London, ON N6A 3K7
- Fetal and Newborn Health Program, Lawson Health Research Institute, London, ON N6C 2V5
- Child Health Research Institute, London Health Sciences Centre, London, ON N6A 3K7
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Oishi M, Yokoyama H, Abe N, Iwasaki K, Okuguchi F, Kawai K, Sugimoto H, Takamura H, Takeda H, Doi K, Hirao K, Ikeda S. Time and cost involved in the care of newly registered patients with diabetes mellitus and other lifestyle diseases at diabetes clinics in Japan (JDDM 4). Diabet Med 2007; 24:1149-55. [PMID: 17888135 DOI: 10.1111/j.1464-5491.2007.02251.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To study the time and cost involved in the care of newly registered outpatients with Type 2 diabetes mellitus (DM), compared with patients with hypertension and/or hyperlipidaemia (HTL). METHODS A total of 313 patients with DM and 58 patients with HTL without diabetes were registered on their first visits to 11 diabetes clinics across Japan. The time and cost involved in their care was recorded over the following 5 months. RESULTS In the first 3 months, there was an extensive time commitment to both groups. The time spent by physicians was 1.5 times longer for DM than for HTL. The total care time spent by all the care providers for DM was twice that for HTL. The cost of DM care was twice that for HTL, with the cost of medicines excluded. However, half of the cost for DM was for laboratory tests. When these were excluded, and the remaining cost divided by the time spent, the amount for DM was half of that for HTL. Over the 5 months, mean glycated haemoglobin (HbA(1c)) in DM patients improved from 8.0% to 6.5%, and 72% of DM patients achieved the glycaemic target of HbA(1c) < or = 6.5%. CONCLUSIONS DM care in a diabetes clinic requires a great deal more time and resources than HTL to achieve the best outcome. An educational system for self care, presently lacking in the primary care setting in Japan, would improve glycaemic control for DM patients in the community.
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Rajan M, Pogach L, Tseng CL, Reiber G, Johnston M. Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement. Prim Care Diabetes 2007; 1:147-153. [PMID: 18632036 DOI: 10.1016/j.pcd.2007.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 05/06/2007] [Accepted: 05/29/2007] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate medical center variation in self-reported knowledge of footcare practices by veterans at high risk for lower extremity complications. METHODS We utilized a previously validated footcare-specific survey from 772 (44% response rate) veterans with diabetes and high-risk foot conditions at eight Veterans Administration facilities that contained items on knowledge of basic (such as how to inspect feet) and specialized self-foot care practices (such as cutting nails and shaving calluses). Linear regression models were used to evaluate facility-level variation in unadjusted and adjusted education (controlling for age, schooling, general, and foot health). RESULTS Participants' average age was 67 years, 94% were male and 34% had 13 years of education. The mean facility basic knowledge score on a four-point ordinal scale was 3.1 (range: 2.9-3.3), where 1=no knowledge and 4=enough knowledge. The specialized knowledge score, using the same scale, was 2.52 (range: 2.2-2.8). There were significant (p<0.005) differences among facilities in both unadjusted and adjusted basic and specialized footcare knowledge. CONCLUSIONS Patient self-reported footcare knowledge was suboptimal and significantly varied across medical centers with and without adjustment for foot-risk factors, general health, and demographic factors.
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Affiliation(s)
- Mangala Rajan
- Center for Healthcare Knowledge Management, Department of Veteran Affairs-New Jersey Health Care System, East Orange, NJ, United States
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Irons BK, Vickers P, Esperat C, Valdez GM, Dadich KA, Boswell C, Cannon S. The Need for a Community Diabetes Education Curriculum for Healthcare Professionals. J Contin Educ Nurs 2007; 38:227-31. [PMID: 17907667 DOI: 10.3928/00220124-20070901-07] [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: 11/20/2022]
Abstract
Healthcare professionals need valuable up-to-date information on diabetes management and skills to treat and educate patients with diabetes mellitus. The Diabetes Education for Healthcare Professionals program was developed to provide healthcare professionals with current diabetes management skills. It was also designed to increase the number of certified diabetes educators in the area in which it was delivered. The program enrolled 147 participants and was delivered on four different occasions. Fifty-five of those participants stated a strong interest in pursuing certified diabetes educator certification, which may significantly increase the number of certified diabetes educators in both rural and urban areas of West Texas.
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Affiliation(s)
- Brian K Irons
- School of Pharmacy, Texas Tech University Health Sciences Center, Lubbock, Texas 79430, USA
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Valdez GM, Dadich KA, Boswell C, Cannon S, Irons BK, Vickers P, Esperat C. Planning and Implementing an Interdisciplinary Diabetes Workshop for Healthcare Professionals. J Contin Educ Nurs 2007; 38:232-7. [PMID: 17907668 DOI: 10.3928/00220124-20070901-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A diabetes education program for healthcare professionals evolved out of a series of discussions among healthcare providers. This group realized the importance and the necessity of developing a current knowledge base for themselves, their clients, and their clients' families. The target audiences for this program were physicians, nurses, pharmacists, and dietitians who could be eligible to work toward becoming a certified diabetes educator. This article discusses the process used to develop and conduct these workshops. The lessons learned during this project are provided for consideration by others seeking to address common concerns and challenges in other areas of clinical practice.
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Affiliation(s)
- Gloria M Valdez
- Nursing Faculty, Covenant School of Nursing, Lubbock, Texas, USA
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References. Am J Kidney Dis 2007. [DOI: 10.1053/j.ajkd.2006.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Piatt GA, Orchard TJ, Emerson S, Simmons D, Songer TJ, Brooks MM, Korytkowski M, Siminerio LM, Ahmad U, Zgibor JC. Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention. Diabetes Care 2006; 29:811-7. [PMID: 16567820 DOI: 10.2337/diacare.29.04.06.dc05-1785] [Citation(s) in RCA: 203] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes. RESEARCH DESIGN AND METHODS This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51). RESULTS A marked decline in HbA(1c) was observed in the CCM group (-0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: -10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02). CONCLUSIONS These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes.
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Affiliation(s)
- Gretchen A Piatt
- Department of Epidemiology, University of Pittsburgh, PA 15213, USA.
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von Sengbusch S, Müller-Godeffroy E, Häger S, Reintjes R, Hiort O, Wagner V. Mobile diabetes education and care: intervention for children and young people with Type 1 diabetes in rural areas of northern Germany. Diabet Med 2006; 23:122-7. [PMID: 16433708 DOI: 10.1111/j.1464-5491.2005.01754.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To improve the quality of care in children with Type 1 diabetes who have limited access to specialized diabetes care in rural areas, by providing a mobile diabetes education and care team, affiliated with a University hospital paediatric diabetes centre. METHODS A cohort of 107 children and their families from eight rural hospitals was followed between July 2000 and July 2002. Parameters on quality of metabolic control (HbA(1c), hospitalization rate and number of episodes of severe hypoglycaemia), diabetes knowledge and quality of life at baseline (t(0)), 6 weeks (t(1)) and 6 months (t(2)) after the interventions were measured. RESULTS Mean HbA(1c) was 7.9 +/- 1.4% at t(0). The proportion of HbA(1c) values < 6.8% increased significantly (P < 0.05) and of values > 8.0% decreased significantly (P < 0.01) at t(1) and t(2). The rate of hospitalization fell significantly by 9.4%, from 16.2% at baseline to 6.8% at t(2) (P < 0.05). The children reported significantly better diabetes-specific quality of life (P < 0.05) and higher self-esteem (P < 0.01) after the intervention. Theoretical diabetes knowledge was increased both in the short and long term (P < 0.05). CONCLUSIONS The intervention improved metabolic control, diabetes knowledge and diabetes-specific quality of life. We conclude that high-quality diabetes care in a rural area can be provided by a mobile diabetes education and care team.
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Affiliation(s)
- S von Sengbusch
- University of Schleswig-Holstein, Campus Lübeck, Division of Pediatrics, Lübeck, Germany
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Hill-Briggs F, Gary TL, Yeh HC, Batts-Turner M, Powe NR, Saudek CD, Brancati FL. Association of Social Problem Solving With Glycemic Control in a Sample of Urban African Americans With Type 2 Diabetes. J Behav Med 2006; 29:69-78. [PMID: 16397820 DOI: 10.1007/s10865-005-9037-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2005] [Indexed: 10/25/2022]
Abstract
The Social Problem-Solving Inventory--Revised, Short Form, was administered to 65 urban African Americans with type 2 diabetes to examine association of generic problem-solving styles and orientation with hemoglobin A1C (A1C). Eighty-five percent of participants had total social problem-solving scores in the Average range or higher. In linear regression models adjusted for education, each interquartile increase in impulsive/careless score was associated with a 0.82 increase in A1C (%) (p = 0.01), and each interquartile increase in avoidant score was associated with a 1.62 increase in A1C (%) (p = 0.004). After adjusting for depressive symptoms, the association of impulsive/careless style with A1C was attenuated, while the association of avoidant problem solving with A1C remained significant (p = 0.01). Associations of rational problem-solving style, positive orientation, and negative orientation with A1C and health behaviors were not statistically significant. Ineffective problem-solving styles may prove to be important targets for intervention to improve glycemic control.
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Affiliation(s)
- Felicia Hill-Briggs
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
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Affiliation(s)
- Susan V. Ponchillia
- Department of Blindness and Low Vision Studies, Western Michigan University, 1903 West Michigan Avenue, Mail Stop 5218, Kalamazoo, MI 49008
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Abstract
OBJECTIVE To emphasize the importance of medical nutrition therapy in the overall management of diabetes. METHODS Published reports of the effectiveness of nutrition intervention in glycemic control are reviewed, and useful strategies for implementation of lifestyle changes in patients with diabetes are discussed. RESULTS In randomized controlled trials of nutrition therapy in patients with diabetes, reduction in hemoglobin A1c levels has been demonstrated. The focus of medical nutrition intervention in patients with diabetes should be strategies that will address the metabolic abnormalities of glucose, lipids, and blood pressure associated with this disease. Early referral for lifestyle changes and advice will yield the most benefit in prevention of development of type 2 diabetes or minimization of progression of the disease if the diagnosis has already been made. Patients should be educated about the progressive nature of type 2 diabetes and the importance of glycemic control, with appropriate food choices and physical activity in conjunction with their antidiabetes medication. CONCLUSION The health-care team can provide practical and useful information to patients with diabetes that will improve management of their disease and enhance their well-being.
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Ginsburg KR, Howe CJ, Jawad AF, Buzby M, Ayala JM, Tuttle A, Murphy K. Parents' perceptions of factors that affect successful diabetes management for their children. Pediatrics 2005; 116:1095-104. [PMID: 16263995 DOI: 10.1542/peds.2004-1981] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To learn which factors parents perceive to be most influential in determining successful type 1 diabetes management. METHODS A 4-stage mixed qualitative-quantitative method that consists of a series of focus groups, a survey, and in-depth interviews was used to ensure that parents generated, prioritized, and explained their own ideas. In each stage, parents offered a new level of insight into their perception of how children achieve good metabolic control while living as normal a life as possible. The survey responses were divided into statistically different ranks, and the Kruskal-Wallis test was used to compare the results between subgroups. RESULTS A total of 149 parents participated in the formative qualitative phases, 799 families (66%) responded to the parent-generated survey, and 67 explanatory interviews were conducted. The families who responded to the survey had children of varied ages (mean: 11.9 years; SD: 4.44) and diabetes control (mean hemoglobin A1c: 8.22%; SD: 1.65); 84.1% of respondents were white, 12.3% were black, and 89% were privately insured. The 30 survey items were statistically discriminated into 8 ranks. The items cover a wide range of categories, including concrete ways of achieving better control, families' or children's traits that affect coping ability, actions of the health care team that support versus undermine families' efforts, and the availability of community supports. No clear pattern emerged regarding 1 category that parents perceived to matter most. CONCLUSIONS Clinicians can affect many of the factors that parents perceive to make a difference in whether they can successfully raise a resilient child in good diabetes control. Future research needs to determine whether health care teams that address the concerns that parents raised in this study are more effective in guiding children to cope well with diabetes, to incorporate healthier lifestyles, and ultimately to achieve better metabolic control.
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Affiliation(s)
- Kenneth R Ginsburg
- Division of Adolescent Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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Strine TW, Okoro CA, Chapman DP, Beckles GLA, Balluz L, Mokdad AH. The impact of formal diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes. Prev Med 2005; 41:79-84. [PMID: 15916996 DOI: 10.1016/j.ypmed.2004.10.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2004] [Revised: 09/04/2004] [Accepted: 10/19/2004] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diabetes-related morbidity and mortality are primarily attributable to complications such as heart disease, stroke, lower extremity amputation, kidney disease, blindness, and visual impairment, many of which potentially can be delayed or prevented. METHODS We examined the association of diabetes self-management education (DSME) with preventive health practices and behaviors among 22,682 persons with type 2 diabetes using data from the 2001 and 2002 Behavioral Risk Factor Surveillance System (BRFSS). BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of noninstitutionalized adults aged > or = 18 years. RESULTS Approximately 48% of all adults with type 2 diabetes had never attended a DSME course. Among both diabetic persons who used insulin and those who did not, persons who received DSME were significantly more likely than those who had not received training to be physically active, to have received an annual dilated eye exam and flu vaccine, to have received a pneumococcal vaccine, to have checked their blood sugar daily, and to have had a physician or other health professional check their feet for sores or irritations and their hemoglobin A1C level in the past year. CONCLUSIONS These data indicate the importance of DSME in the promotion of health practices that could prevent or delay potential diabetes complications among persons with type 2 diabetes.
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Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-66, Atlanta, GA 30341, USA.
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McMahon GT, Gomes HE, Hohne SH, Hu TMJ, Levine BA, Conlin PR. Web-based care management in patients with poorly controlled diabetes. Diabetes Care 2005; 28:1624-9. [PMID: 15983311 PMCID: PMC1262644 DOI: 10.2337/diacare.28.7.1624] [Citation(s) in RCA: 208] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the effects of web-based care management on glucose and blood pressure control over 12 months in patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS For this study, 104 patients with diabetes and HbA(1c) (A1C) > or =9.0% who received their care at a Department of Veterans Affairs medical center were recruited. All participants completed a diabetes education class and were randomized to continue with their usual care (n = 52) or receive web-based care management (n = 52). The web-based group received a notebook computer, glucose and blood pressure monitoring devices, and access to a care management website. The website provided educational modules, accepted uploads from monitoring devices, and had an internal messaging system for patients to communicate with the care manager. RESULTS Participants receiving web-based care management had lower A1C over 12 months (P < 0.05) when compared with education and usual care. Persistent website users had greater improvement in A1C when compared with intermittent users (-1.9 vs. -1.2%; P = 0.051) or education and usual care (-1.4%; P < 0.05). A larger number of website data uploads was associated with a larger decline in A1C (highest tertile -2.1%, lowest tertile -1.0%; P < 0.02). Hypertensive participants in the web-based group had a greater reduction in systolic blood pressure (P < 0.01). HDL cholesterol rose and triglycerides fell in the web-based group (P < 0.05). CONCLUSIONS Web-based care management may be a useful adjunct in the care of patients with poorly controlled diabetes.
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Affiliation(s)
| | | | | | | | | | - Paul R. Conlin
- Address correspondence to: Paul R. Conlin, M.D., VA Boston Healthcare System (151-DIA), 150 South Huntington Avenue, Boston, MA 02130, 617-732-8489 (phone), 617-732-5764 (fax),
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Cohen O, Birnbaum GE, Meyuchas R, Levinger Z, Florian V, Mikulincer M. Attachment orientations and spouse support in adults with type 2 diabetes. PSYCHOL HEALTH MED 2005. [DOI: 10.1080/1354850042000326575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kim S, Love F, Quistberg DA, Shea JA. Association of health literacy with self-management behavior in patients with diabetes. Diabetes Care 2004; 27:2980-2. [PMID: 15562219 DOI: 10.2337/diacare.27.12.2980] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sarang Kim
- Clinical Academic Building, 2nd Floor, 125 Paterson St., New Brunswick, NJ 08901, USA.
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Lorber DL, Chavez S, Dorman J, Fisher LK, Guerken S, Haas LA, Hill JV, Kendall D, Puisis M, Salomone K, Shansky RM, Wakeen B. Diabetes management in correctional institutions. Diabetes Care 2004; 27 Suppl 1:S114-21. [PMID: 14693945 DOI: 10.2337/diacare.27.2007.s114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Third-party reimbursement for diabetes care, self-management education, and supplies. Diabetes Care 2004; 27 Suppl 1:S136-7. [PMID: 14693952 DOI: 10.2337/diacare.27.2007.s136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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