bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of a Literacy Assessment Tool for Persons With Diabetes
Authors: Nath Charlotte Reese , Sylvester Shirley Theriot , Yasek Van , Gunel Erdogan
Published: April 2008

PURPOSE

this research was conducted to develop a valid, reliable, quick, and nonstigmatizing tool for assessing literacy in the healthcare setting.

METHODS

The Literacy Assessment for Diabetes (LAD) instrument was developed as a word recognition test composed of 3 graded word lists in ascending difficulty. This literacy test, which was specific to diabetes, measured a patient's ability to pronounce terms that they would encounter during clinic visits and in reading menu and self-care instructions. The majority of the terms were on a 4th-grade reading level, with the remaining words ranging from the 6th- through 16th-grade levels. To assess reliability and validity, the LAD was compared with the Wide Range Achievement Test (WRAT3) and the Rapid Estimate of Adult Literacy in Medicine (REALM) by administering all 3 tests to 203 participants in a test-retest study design.

RESULTS

All 3 tests (LAD, REALM, and WRAT3) reliably detected true intrasubject variation in word recognition from test to retest. In addition, LAD measured word recognition ability similar to the REALM and WRAT3.

CONCLUSIONS

The LAD is a reliable and valid instrument for measuring literacy in adults with diabetes. It can be administered in 3 minutes or less, and the raw score is scaled to a reading grade level.
Development of the Diabetes Problem-Solving Measure for Adolescents
Authors: Cook Sandy , Aikens James E. , Berry Carolyn A. , MoNabb Wylle L.
Published: April 2008

PURPOSE

this paper describes the development and psychometric properties of the Diabetes Problem-Solving Measure for Adolescents (DPSMA).

METHODS

The DPSMA is a structured, interview-based questionnaire that examines how adolescents with type 1 diabetes solve diabetes-related self-management problems. Seventeen diabetes-related self-management problem vignettes were derived from a survey of adolescents and their parents. The vignettes were reviewed and finalized by a multidisciplinary team of diabetes experts. A sample of 43 adolescents, 13 to 17 years old, with type 1 diabetes, was used to establish the psychometric properties of the instrument.

RESULTS

The scale demonstrated acceptable internal consistency and interrater reliability. Predicted relationships with scores on concurrently administered measures of adherence, diabetes quality of life, and metabolic control provided support for construct validity.

CONCLUSIONS

The results suggest that the DPSMA has acceptable internal consistency, interrater reliability, and construct validity. It may be a useful tool to help healthcare providers understand the diabetes-related problem-solving abilities of their adolescent patients.
Syringe Disposal Practices and Gender Differences
Authors: McConville Debra E. , Hamilton Edith M.
Published: April 2008

PURPOSE

The purpose of this study was to describe syringe disposal practices of individuals with diabetes who take insulin and to investigate the attitude toward and effect of previous information on proper syringe disposal.

METHODS

Adult men and women who injected insulin were recruited from an endocrinology practice and given 2 questionnaires concerning syringe disposal practices and attitude toward proper syringe disposal. Completed questionnaires were returned by mail to the investigator. Nonparametric statistical procedures were used to analyze the data.

RESULTS

Men with higher income tended to use the trash for syringe disposal more often than lower income men, and older women exhibited a higher positive attitude score than younger women. A positive attitude significantly correlated with the likelihood of proper syringe disposal, and those who had received previous information were more likely to dispose of syringes properly. Healthcare providers were identified as the main source of information.

CONCLUSIONS

Diabetes educators can improve the syringe disposal practices of their patients through education at each office visit. Knowing more about the environmental and social problems that may ensue from improper syringe disposal may influence patients to practice better disposal methods.
Do Persons With Diabetes Know Their (AIC) Number?
Authors: Harwell Todd S. , Dettori Nancy , McDowall Janet M. , Quesenberry Kim , Priest Linda , Butcher Marcene K. , Flook Benjamin N. , Helgerson Steven D. , Gohdes Dorothy
Published: April 2008

PURPOSE

The objective of this study was to compare self-reported knowledge about Al C testing with information from the medical record.

METHODS

A telephone survey was conducted among patients with diabetes in a rural fee-for-service practice and a community health center. Self-reported information regarding Al C testing, the last Al C value, and perceived blood glucose control was compared with the most current Al C value documented in the medical record.

RESULTS

Seventy five percent of survey respondents reported having 1 or more Al C tests in the past year, which generally agreed with information from their medical records. However, only 24% of those who reported having a test remembered the actual value, and the self-reported values correlated weakly with the last Al C on the medical record. Among those with a documented Al C value, half described their blood glucose as very well controlled. The last Al C value, however, was <7.0% in only half of those respondents.

CONCLUSIONS

Persons with diabetes were aware of their previous Al C testing but did not interpret the values accurately in relation to their own glycemic control. If clinicians expect patient knowledge and understanding of glycemic control measures to improve outcomes of care, patient education will need to emphasize the meaning of these values.
Functional Health Status of Persons With Diabetes in a Nurse-Managed Clinic
Authors: Hartley Lou Ann
Published: April 2008

PURPOSE

The purpose of this psychometric analysis was to (1) describe the functional health status of medically underserved persons with diabetes participating in an exercise program; (2) examine the relationships between functional health status scores and physiologic measures for blood pressure, heart rate, and blood glucose levels; and (3) examine the reliability and validity of the Medical Outcomes Study SF-36 survey.

METHODS

Data were collected from 31 men and women receiving diabetes disease management in a community-based nurse-managed clinic. The SF-36 survey was used to measure functional health status. Blood pressure, heart rate, and blood glucose also were measured (pretestlposttest).

RESULTS

The SF-36 survey had good internal consistency in the total sample. Blood pressure and blood glucose levels decreased significantly and heart rate increased significantly from pretest to posttest. Functional health status was negatively associated with physiological parameters.

CONCLUSIONS

Further research is needed on the use of the SF-36 survey in medically underserved persons with diabetes because this instrument lacked construct validity as a measure of functional health status in this population.
Increasing Problem Solving in Adolescents With Type 1 Diabetes: The Choices Diabetes Program
Authors: Cook Sandy , Herold Kevan , Edidin Deborah V. , Briars Rosemary
Published: April 2008

The purpose of this pilot study was to test the hypothesis that adolescents with type 1 diabetes can learn to become better problem solvers in diabetes self-care and thereby improve their metabolic control.

METHODS

Fifty-three adolescents aged 13 to 17 with type 1 diabetes were randomly assigned to either a 6-week problem-solving diabetes education program or to a control group (usual care). Al C levels were obtained as well as assessments of problem solving, frequency of behavior, level of responsibility, and 24-hour behavior recall at baseline and 6 months.

RESULTS

The experimental group participants showed significantly improved problem-solving test scores and Al C values from baseline to 6 months, changes not evident in the control group. At 6 months, the experimental group participants were doing blood glucose testing more often than those in the control group. However, there was no significant difference in problem-solving test scores or Al C values.

CONCLUSIONS

This 6-week intervention for adolescents with diabetes resulted in better problem-solving skills, more frequent blood glucose testing, and improved Al C values. The results suggest that a diabetes problem-solving program for adolescents can be effective in improving metabolic control.
Culturally Competent Dietary Education for Southern Rural African Americans With Diabetes
Authors: Anderson-Loftin Wanda , Barnett Steve , Sullivan Patra , Bunn Peggy Summers , Tavakoli Abbas
Published: April 2008

PURPOSE

The purpose of this article is to describe a culturally competent, dietary self-management intervention designed to improve physiological outcomes, diabetes self-management, and costs of care for high-risk African Americans with type 2 diabetes.

METHODS

A longitudinal, quasi-experimental design was used to evaluate the effectiveness of the intervention for 23 adult African Americans from a physician practice group in rural South Carolina. The intervention consisted of 4 low-fat dietary education classes, 6 discussion groups, and follow-up. Intervention sessions were provided by a dietitian and nurse case managers and framed as social events; families were encouraged to participate.

RESULTS

Data suggest that the intervention significantly improved fat-related dietary habits, Al C values, fasting blood glucose, and frequency of acute care visits. A trend in reduction of lipids and weight also was observed.

CONCLUSIONS

Culturally competent dietary self-management provides a meaningful approach to focused diabetes education for rural African Americans. Integrating nursing case management provides an innovative method of addressing the more global issues of delivery of care to underserved rural populations and decreasing the high costs of care.
Insulin Lispro Update
Authors: Meece Jerry D. , Campbell R. Keith
Published: April 2008

PURPOSE

This paper provides a review of the literature and clinical studies for insulin lispro and updated information on its advantages over regular insulin for various populations of people with diabetes.

METHODS

Information was gathered from a search of Medline articles and from review of clinical studies.

RESULTS

Patients in various special populations using insulin lispro, with proper adjustment of basal insulin, had a greater reduction in hemoglobin Al C and fewer episodes of hypoglycemia than patients on regular insulin.

CONCLUSIONS

More recently published literature shows that due to its faster onset and shorter duration of action, insulin lispro is useful for not only lowering Al C values, but also for reducing hypoglycemic events in various populations with diabetes, including pediatric and pregnant patients, those with gastroparesis, and insulin pump users.
A Systematic Literature Review of the Effectiveness of Diabetes Education of School Personnel
Authors: Nichols Phyllis J. , Norris Susan L.
Published: April 2008

PURPOSE

This paper describes current knowledge levels of school personnel about diabetes, discusses the findings of a systematic review of the literature on the effectiveness of diabetes educational interventions for school personnel, and presents recommendations for future research.

METHODS

English language literature published between January 1966 and May 2001 regarding the effectiveness of diabetes education of school personnel was systematically reviewed using multiple electronic databases.

RESULTS

Four studies that examined the effectiveness of diabetes education of school personnel were identified. One study demonstrated improvement in teacher knowledge of treatment, another reported significant improvement in comprehensive knowledge scores, and a third study demonstrated significant knowledge deficits across 4 measures of teacher knowledge about diabetes. A fourth study demonstrated a decrease in the cumulative frequency of diabetic ketoacidosis.

CONCLUSIONS

The literature regarding the effectiveness of diabetes education of school personnel is scant, the methodology is inadequate, the results are mixed, and the focus is on a narrow range of outcomes. Further research is needed to define effective interventions for improving the health and quality of life of school-age children and adolescents with diabetes.
Prevention of Overweight and Obesity in Children: Influences on the Food Environment
Authors: Haire-Joshu Debra , Nanney M. S.
Published: April 2008

PURPOSE

There is an epidemic of pediatric overweight and obesity leading to type 2 diabetes in youth. The purpose of this review is to describe the multiple paths of influence on the food environment of youth and to identify diabetes education strategies focused on early prevention of overweight and obesity.

METHODS

A review of relevant professional literature was conducted.

RESULTS

Models of obesity prevention in youth need to address genetic factors that influence the development of food preferences in the young child, parenting influences on eating pattern development, and access and availability of foods in the physical environment of the child.

CONCLUSIONS

Early intervention with parents of young children is required to prevent the development of eating patterns that lead to pediatric obesity and type 2 diabetes in youth. Diabetes educators need to be able to inform parents of the multiple paths of influence on the food environment of the child and suggest strategies to encourage the development of positive food preferences and intake.
Nocturnal Polyuria in Type 2 Diabetes: A Symptom of Obstructive Sleep Apnea
Authors: Chasens Eileen R. , Umlauf Mary Q. , Pillion Dennis J. , Wells Judy A.
Published: April 2008

PURPOSE

Polyuria and nocturia in individuals with type 2 diabetes may be due to obstructive sleep apnea (OSA), a recently recognized etiology of excess nighttime urine production. This exploratory study examined the relationships among glucose control, OSA, and nocturnal urine production.

METHODS

A sample of community-dwelling older adults (20 nondiabetic subjects and 10 poorly controlled type 2 diabetes subjects) was recruited based on self-report of nocturia more than twice per night. Participants were monitored on a metabolic research unit for 24 hours to track intake/output, collect blood and urine samples, and conduct an overnight polysomnography sleep study.

RESULTS

None of the subjects had fasting serum glucose levels above the renal threshold. OSA was found in 65% of subjects. Those with moderate/severe OSA had significantly greater overnight urine production than subjects without OSA. Subjects with type 2 diabetes and moderate/severe OSA had the highest nocturnal urine production.

CONCLUSIONS

The high incidence of undetected OSA in subjects with type 2 diabetes with nocturia suggests that nocturia, OSA, and type 2 diabetes frequently coexist and may be interrelated.
The Impact of Self-Monitoring of Blood Olucose on Self-Efficacy and Pregnancy Outcomes in Women With Diet-Controlled Gestational Diabetes
Authors: Homko Carol J. , Sivan Eyal , Reece E. Albert
Published: April 2008

PURPOSE

The purpose of this study was to examine the effects of self-monitoring of blood glucose (SMBG) on feelings of self-efficacy, dietary compliance, and pregnancy outcomes in women with diet-controlled gestational diabetes mellitus (GDM).

METHODS

Fifty-eight women with GDM and a fasting blood glucose level <95 mg/dL were randomly assigned to 2 groups. The experimental group measured their blood glucose levels 4 times daily using a reflectance meter with memory. Metabolic status was assessed in the control group by periodic monitoring at prenatal visits. Otherwise the management protocol was identical for both groups. The Diabetes Empowerment Scale was completed at study entry and at 37 weeks gestation to assess feelings of self-efficacy. Dietary compliance was assessed at each visit.

RESULTS

Both groups of women achieved excellent glucose control; only 1 woman in each group required insulin therapy. There were no significant differences with regard to feelings of self-efficacy, dietary compliance, birth weight, gestational age at delivery, Apgar scores, and neonatal complications. Rates of macrosomia, delivery by cesarean section, and occurrence of birth trauma were similar.

CONCLUSIONS

SMBG appears to have little effect on maternal feelings of self-efficacy, dietary compliance, or pregnancy outcomes in women with diet-controlled GDM.
An Initiative to Improve Diabetes Care Standards in Healthcare Organizations Serving Minorities
Authors: Hosler Akiko S. , Godley Kathryn , Rowland Daniel H.
Published: April 2008

PURPOSE

this study was designed to assess changes of diabetes care standards in healthcare organizations that participated in 2-year initiative to improve diabetes care and expand outreach in minority communities.

METHODS

An independent sample of the medical records of adults with type 2 diabetes was randomly drawn at 3 points of time (N=829). Rates of compliance with 20 selected measures of standards of basic diabetes care were measured and compared over time.

RESULTS

Significant improvements in compliance rates from baseline to the end point were found in 11 measures including annual hemoglobin A1 C testing (65.8% to 76.3%), annual lipid profile (33.8% to 49.1%), and biannual lower extremity examination (40.0% to 56.3%).

CONCLUSIONS

Improvements in diabetes care were credited with giving providers feedback on their compliance and increasing support of patient self-care, especially through tailoring outreach and services to minorities.
Diabetes Care Processes and Outcomes in Patients Treated by Nurse Practitioners or Physicians
Authors: Lenz Elizabeth R. , Mundinger Mary O'Neil , Hopkins Sarah C. , Lin Susan X. , Smolowitz Janice L.
Published: April 2008

PURPOSE

the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners (NPs) and physicians (MDs) in the primary care of adults with type 2 diabetes.

METHODS

Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and randomized to an NP or MD practice. Chart reviews were conducted to assess processes of care; patient interviews and hemoglobin Al C (Al C) testing were performed to measure patient outcomes.

RESULTS

NPs were more likely than MDs to document provision of general diabetes education and education about nutrition, weight, exercise, and medications. They were more likely to document patient height, urinalyses results, and Al C values. No differences were found in documenting current medications; alcohol, illicit drug, or tobacco use; depression; weight and blood pressure; foot and cardiovascular exams; blood glucose and creatinine testing; or referral to ophthalmologists. No differences were found in patient outcomes.

CONCLUSIONS

This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes. NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs; however, these differences were not reflected in 6-month patient outcomes.
Protocol for Outpatient Screening and Initiation of Continuous Subcutaneous Insulin Infusion Therapy: Impact on Cost and Quality
Authors: Sanfield Jeffrey A. , Hegstad Marcia , Hanna Raouf S.
Published: April 2008

PURPOSE

the purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 1A years.

METHODS

One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2½ years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin Al C (Al C) were measured and compared.

RESULTS

The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). Al C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections.

CONCLUSIONS

A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2½ years.
Impact of Diabetes Disclosure on Perceptions of Eating and Self-Care Behaviors
Authors: Berlin Kristoffer S. , Sass Daniel A. , Davies W. Hobart , Hains Anthony A.
Published: April 2008

PURPOSE

This study investigated whether disclosure of diabetes and gender influenced perceptions of eating and self-care behaviors.

METHODS

A vignette was developed in which a hypothetical friend engaged in diabetes self-care behaviors during a meal. Respondents (231 young adults) read vignettes that varied according to a 2 x 2 design (male vs female, preventative disclosure vs nondisclosure of diabetes). Participants answered 12 questions, which resulted in 2 factors: concern for friend and encourage professional help.

RESULTS

Significantly higher scores resulted on the concern for friend and encourage professional help factors when diabetes was not disclosed. Female characters also received significantly higher scores on the concern for friend factor.

CONCLUSIONS

Individuals with diabetes who choose to disclose their illness may prevent negative or incorrect perceptions related to self-care and eating behaviors, and may have a decreased likelihood that a true eating disorder would be identified by others.
Reliability and Validity of a Measure of Perceived Diabetes and Dietary Competence in African American Women With Type 2 Diabetes
Authors: Samuel-Hodge Carmen D. , DeVellis Robert F. , Ammerman Alice , Keyserling Thomas C. , Elasy Tom A.
Published: April 2008

PURPOSE

General measure of perceived diabetes and dietary competence (PDDC) was developed to assess a person's sense of confidence and perceived behavioral control in diabetes and dietary self-management. Internal structure, reliability, and construct validity were evaluated.

METHODS

There were 2 samples of African American women with type 2 diabetes; 226 patients in the development sample and 225 patients in the validation sample. Factor analysis, Cronbach's coefficient alpha, and correlation analysis were used to assess reliability and validity of the PDDC measure.

RESULTS

Three subscales were empirically determined by factor analysis: positive competence, negative dietary competence, and negative control. Cronbach's alphas for all subscales were good. Predicted relationships with measures of perceived health competence, self-efficacy, social support, and perceived dietary barriers were largely supported in construct validation.

CONCLUSIONS

This study provides initial support for the internal reliability and validity of a perceived diabetes and dietary competence measure. Further research is needed to determine its validity in other samples of African Americans with type 2 diabetes and its clinical utility in evaluating diabetes self-management training.
Perceived Adherence to Prescribed or Recommended Standards of Care Among Adults With Diabetes
Authors: Jorgensen Wendy A. , Pollvka Barbara J. , Lennie Terry A.
Published: April 2008

PURPOSE

Adults with diabetes were surveyed to determine the extent to which respondents perceived specific preventive regimens (diet, exercise, weight control, and education) had been prescribed or recommended, adhered to their prescribed regimens, and identified barriers to nonadherence.

METHODS

Surveys were mailed to 2 samples of adults diagnosed with diabetes. The clinic sample was from health department clinics (n=264); the agency sample was from a nonprofit agency serving people with diabetes (n=1 11).

RESULTS

Of the 4 preventive measures under investigation, diet plans and weight reduction were perceived as most commonly recommended by health professionals; exercise schedules were the least commonly recommended. Diabetes self-management education was reportedly recommended more often among the agency sample. In terms of adherence, approximately half of both samples were able to lose weight. A smaller portion of the clinic sample was able to get needed foods and exercise, and maintain weight loss. The most frequently cited reasons for nonadherence were cost, transportation, and other health conditions.

CONCLUSIONS

Improvement in the implementation of preventive behaviors is needed, particularly exercise schedules. Barriers to care, such as costs and transportation, may need special consideration.
Quality Improvement Initiative to Integrate Teaching Diabetes Standards Into Home Care Visits
Authors: Jonos Phyllis M.
Published: April 2008

PURPOSE

This quality improvement project was initiated to determine the quality of diabetes care for clients of a home health agency and to integrate the teaching of diabetes standards of care into home care nursing visits.

METHODS

A descriptive study design was used to evaluate the effectiveness of teaching materials and the Standards of Care Teaching Program. Performance indicators and outcome measures from the American Diabetes Association Provider Recognition Program (ADA PRP) were used to determine the baseline status of diabetes care and for comparing performance measures from 50 home care clients.

RESULTS

The educational materials and care plan interventions helped nurses learn the standards and facilitated tracking interventions and performance measures. These results showed statistical significance in performance measures for eye, foot, lipid tests, and diabetes self-management education, but not for hemoglobin Al C, urine protein, and medical nutrition therapy.

CONCLUSIONS

The Standards of Care Teaching Program was a useful way to integrate the standards into a diabetes program and home care visits. Comparing clients' diabetes performance measures with national standards helped identify specific areas for quality improvement.
Diabetes Self-Management in African Americans: An Exploration of the Role of Fatalism
Authors: Egede Leonard E. , Bonadonna Ramita J.
Published: April 2008

PURPOSE

This study was conducted to explore the concept of fatalism in relation to diabetes self-management behavior in African Americans with type 2 diabetes.

METHODS

Participants (n=39) were recruited from a clinic sample of African Americans with type 2 diabetes. Seven focus groups were conducted; the sessions were recorded, transcribed, and analyzed to identify themes related to fatalism and diabetes self-management. The ISAS paradigm (individual, symbols, audience, situation), a social psychology theory, provided the theoretical framework for the study.

RESULTS

Four dimensions of fatalism were identified: the meaning of diabetes, the illness experience, the individual's coping response, and the individual's religious and spiritual beliefs. For the participants in this study, fatalism seemed to characterize the nature of the interaction between the individual with diabetes and others, the meanings they attached to such interactions, and the decision to adopt an effective or ineffective diabetes self-management behavior.

CONCLUSIONS

Fatalism was associated with diabetes self-management in African Americans with diabetes and was multidimensional in this population; the construct appeared to differ conceptually from the perspective of current measures.
Insights From Older Adults With Type 2 Diabetes: Making Dietary and Exercise Changes
Authors: Dye Cheryl J. , Haley-Zitlin Vivian , Willoughby Deborah
Published: April 2008

PURPOSE

The purpose of this research was to identify factors that affect the nutrition and exercise behaviors of persons over the age of 55 with type 2 diabetes.

METHODS

Focus groups were conducted using a validated focus group interview guide to determine primary health concerns and health behaviors, favored learning modalities, barriers to learning, food preferences, and exercise preferences.

RESULTS

The following major themes and subthemes were identified: some risk factors for diabetes and heart disease seem more salient than others; perceived susceptibility for serious outcomes of diabetes can occur through vicarious learning; willpower, often obtained through a belief in God, is necessary for successful behavior change; effective modification of behavior and building self-efficacy starts with small steps; and intrinsic reinforcement is necessary for behavior change.

CONCLUSIONS

These data were used to identify strategies and messages to enhance adherence to nutrition and activity recommendations for persons with type 2 diabetes and accompanying cardiovascular risk factors.
Stage of Change Advancement for Diabetes Self-Management Behaviors and Glucose Control
Authors: Parchman Michael L. , Arambula-Solomon Teshia G. , Noël Polly Hitchcock , Larme Anne C. , Pugh Jacqueline A.
Published: April 2008

PURPOSE

This study was conducted to evaluate whether patients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-management behaviors and to determine if movement was related to glucose control.

METHODS

A cohort of 428 patients with type 2 diabetes participated in a traditional diabetes education program in a large urban center in the Southwest. The sample was predominantly female with less than a high school education, a mean age of 52 years, and a mean duration of diabetes of 7 years. Two interviews were conducted approximately 9 months apart, at 1 to 4 weeks before the educational program and at 6 months after completing it. Blood specimens were collected at each interview to measure hemoglobin A1C (A1C) levels.

RESULTS

Most of the patients advanced 1 or more stages of change for at least 1 self-management behavior. Those with diabetes for less than 2 years were significantly more likely to advance at least 1 stage of change for diet and exercise than those with diabetes for more than 2 years. Such advancement was significantly associated with a decline in A1C.

CONCLUSIONS

Patients with type 2 diabetes who participated in diabetes education advanced through stages of change for self-care behaviors. The intervention was more effective for those with a shorter duration of diabetes.
Condom Use, Pregnancy, and STDs in Adolescent Females With and Without Type 1 Diabetes
Authors: Falsetti Donna , Charron-Prochownik Denise , Sereika Susan , Kitutu Julius , Peterson Karen , Becker Dorothy , Jacober Scott , Mansfield Joan , White Neil H.
Published: April 2008

PURPOSE

The purpose of this secondary analysis was to describe and compare adolescent females with and without diabetes in terms of use of condoms, pregnancy outcomes, and sexually transmitted disease (STD) outcomes.

METHODS

Data from a multisite, case-controlled, telephone survey study were used in a secondary analysis to evaluate the parameters stated in the purpose.

RESULTS

The 87 females with type 1 diabetes and 45 nondiabetic females who participated were 16 to 22 years old. Most were Caucasian, in high school, and lived with their parents. No demographic differences were noted between the groups. Of those sexually active, for both groups, the most common contraceptive method was male condoms. Four females with diabetes and 2 without diabetes reported an unplanned pregnancy. Three females with diabetes reported an STD infection (chlamydia or trichomonas). Five females with diabetes and 4 nondiabetic females had abnormal pap tests.

CONCLUSIONS

Adolescent females with and without diabetes engaged in less than optimally protected sexual activity, which increased their risk for unplanned pregnancies and STD infections. Further research is needed of the incidence, treatment, and short-term and long-term complications of STDs in adolescent females with diabetes.
A Survey of the Perceptions, Knowledge, and Use of A1C Values by Home Care Patients and Nurses
Authors: Setter Stephen M. , Corbett Cynthia F. , Campbell R K , Cook Dave , Gates Brian J.
Published: April 2008

PURPOSE

The purpose of this study was to provide baseline information on the perceptions, use, and knowledge of hemoglobin A1C (A1C) values among home healthcare nurses and patients.

METHODS

A convenience sample (44 patients, 26 nurses) from a Medicare-certified home care agency was surveyed using an investigator-developed demographic and knowledge questionnaire. Data collected from telephone interviews (patients), written questionnaires (nurses), and medicA1 record reviews were analyzed using descriptive methods.

RESULTS

Most of the home care nurses correctly identified the American Diabetes Association's recommendation for target A1C values; however, nurses rarely contact the physician to obtain A1C results. Nurses do not routinely teach patients about A1C values and inconsistently use A1C values to plan care for their patients with diabetes. Most patients said that they had never had an A1C test performed, and most did not recall the nurse providing any teaching about A1C.

CONCLUSIONS

Education related to target A1C values is needed. Methods to increase the availability of A1C results in the home care setting should be explored. The importance and clinicA1 utility of A1C values need to be more effectively conveyed to both nurses and patients in the home care setting.
Adolescents' Behavioral Autonomy Related to Diabetes Management and Adolescent Activities/Rules
Authors: Hanna Kathleen M. , Guthrie Diana
Published: April 2008

PURPOSE

the purpose of this preliminary study was to describe and explore the behavioral autonomy (both independent functioning and decision making) of adolescents with type 1 diabetes.

METHODS

A sample of 34 adolescents with type 1 diabetes completed checklists on independent functioning and decision making for daily and nondaily diabetes management as well as typical adolescent activities/rules.

RESULTS

Independent functioning in daily diabetes management was greater for older adolescents. Independent functioning and decision making for daily diabetes management, nondaily diabetes management, and typical adolescent activities/rules were strongly correlated. Independent decision making, but not independent functioning for daily diabetes management, was significantly correlated to metabolic control.

CONCLUSIONS

The strong relationship between independent decision making and functioning suggests that both aspects are important parts of behavioral autonomy to be assessed by healthcare professionals working with adolescents with type 1 diabetes. Healthcare professionals should encourage parental involvement that facilitates adolescents' independent decision making, which was related to better metabolic control in this study.
A Systematic Review of Diabetes Self-Care Interventions for Older, African American, or Latino Adults
Authors: Sarkisian Catherine A. , Brown Arieen F. , Norris Keith C. , Wintz Ruth L. , Managione Carol M.
Published: April 2008

PURPOSE

this study system dente and exained published self-care ntetion desgd to *nrv glycenu control or quality of life (QoL) among ole, African Americn or Latino adults.

METHODS

Six electronic databases were searchecl Eligible publicato were thoe that described an intervnin to change knowledge, belie, or behavior among adults with diabetes who were either older than 55 years, African American, or Latino, and that measured the outcomes ofglyeic control or QoL.

RESULTS

Twelve studies met the inclusion criteria, of which 8 were rdomized conrlld trials (RCTs). Of the 8 RCTs, i7provd glycemic control was reported in the intervention arm of S RCTs comparedwith the control arm Of the 4 RCTs theat amined QoL, inprd QoL was reported in the idention ann of 1 study Charaaristics of sssid inter dio s ed poor glcmvic control at baseline (AlC>1 1%), adtural or agetaioring the inevto use of group counseling or support, and inzdmt of spouses and adult children.

CONCLUSIONS

Large-scale cinial trials designed according to aural and age cieria speciic for older Ltins and African Americas uh diabetes are needed to determine hbow best to adess this growing publc heath problem.
Meta-Analysis of Randomized Educational and Behavioral Interventions in Type 2 Diabetes
Authors: Gary Tiffany L. , Genkinger Jeanine M. , Guallar Eliseo , Peyrot Mark , Brancati Frederick L.
Published: April 2008

PURPOSE

this meta-analysis was conducted to assess the effect of educational and behavioral interventions on body weight and glycemic control in type 2 diabetes.

MEHODS

Studies selected for analysis were published randomized controlled trials that evaluated educational and behavioral interventions (no drug interventions) in type 2 diabetes (sample size 210). These criteria were applied to searches of electronic databases and relevant bibliographies. Data were independently abstracted by 2 reviewers and adjudicated by consensus.

RESULTS

Of the 63 articles that met the inclusion criteria, 18 provided enough information for pooled estimates of glycohemoglobin (total Ghb, HbA1, or HbA1 C). These 18 studies yielded 2720 participants (sample sizes of 18 to 749). Interventions ranged from 1 to 19 months; follow-up ranged from 1 to 26 months. Glycohemoglobin was reduced by a mean of 0.43%. When results were stratified by quality score, glycohemoglobin was -0.50% and -0.38% for studies with high and low quality scores, respectively. When weighting studies by sample size, fasting blood glucose was reduced by 24 mg/dL and weight by 3 lbs.

CONCLUSIONS

Previous educational and behavioral interventions in type 2 diabetes have produced modest improvements in glycemic control. Future research should refine such interventions and improve methodology.
Intimacy and Women With Type 2 Diabetes: An Exploratory Study Using Focus Group Interviews
Authors: Sarkadi Anna , Rosenqvist Urban
Published: April 2008

PURPOSE

this study explored if and how women perceived diabetes as affecting their social and sexual intimacy and if they wished to receive professional attention for any sexual disturbances that they experience.

METHODS

A series of five focus group interviews were conducted with 33 women with type 2 diabetes, ages 44 to 80 years, who also completed a questionnaire on sexual functioning. Two thirds were married and one third were sexually active.

RESULTS

Categories resulting from the qualitative analysis were guilt and embarrassment in diabetes; female intimacy and shame; sexual dysfunction, an invisible problem; and the female patient. Asking women about intimacy revealed self-blame and embarrassment regarding their diabetes and sexual functioning. Several women who had experienced sexual dysfunction described barriers that made it difficult to obtain optimal care and/or self-care measures to cope with vaginal dryness, pain during intercourse, and decreased desire. Many of the women had the social and emotional resources to cope with their disease. Nonetheless, they experienced guilt, shame, and embarrassment, which are potentially oppressive features of having type 2 diabetes.

CONCLUSIONS

Asking women with type 2 diabetes about intimacy in a contextually adequate way at routine follow-up visits could give them a chance to discuss both sexual and social intimacy concerns related to their diabetes.
Self-Management of Type 2 Diabetes: A Survey of Low-lncome Urban Puerto Ricans
Authors: von Goeler Dorothea S. , Rosal Milagros C. , Ockene Judith K. , Scavron Jeffrey , De Torrijos Fernando
Published: April 2008

PURPOSE

this study explored self-reported barriers to diabetes self-management in a population of urban, low-income Puerto Rican individuals.

METHODS

A cross-sectional exploratory survey was conducted with 30 Puerto Rican adults with type 2 diabetes. Participants were randomly selected and recruited from a health center, an elder center, and a community outreach database. A survey was used to assess participants' diabetes-related knowledge, attitudes, and patterns of and barriers to self-management.

RESULTS

Participants were older and had limited education and good access to health care. Although two thirds had participated in diabetes education, most demonstrated major deficits in diabetes knowledge. Negative attitudes about living with diabetes were common as was dietary knowledge and nonadherence. Most participants were overweight or obese, did regular self-monitoring of blood glucose but did not use the results to improve their diabetes control, and frequently missed doses of their diabetes medications. Self-reported barriers to self-management were financial and social obstacles and competing health and family concerns.

CONCLUSIONS

The knowledge and self-management behaviors in this population of Puerto Rican individuals with type 2 diabetes need to be improved.
The Effect of an Aerobic Exercise Training Program on Quality of Life in Type 2 Diabetes
Authors: Holton D. Robb , Colberg Sheri R. , Nunnold Tanja , Parson Henri K. , Vinik Aaron I.
Published: April 2008

PURPOSE

The purpose of this study was to determine the effect of 10 weeks of moderate aerobic exercise training on quality of life (QOL) and selected physiological parameters in previously sedentary persons with diabetes.

METHODS

A quality-of-life survey (SF36v2 health survey) and measurement of physiological parameters were completed before and after 10 weeks of supervised aerobic exercise training 3 days a week for 20 to 45 minutes by subjects with diabetes (n=9) and control subjects (n=1 0). Nontraining subjects with diabetes (n=12) and control subjects (n=1 0) also completed the QOL survey at equivalent times.

RESULTS

Participants in all groups had similar characteristics. A training effect was evident in exercisers, with an increase in lactate threshold and a decrease in percent body fat for both groups. Training did not affect body mass index or interstitial nitric oxide levels. Physical and mental component scores on the QOL survey in the training and nontraining groups did not differ significantly before or after the training, and diabetes status had no significant effect on these scores.

CONCLUSIONS

No physiological changes were significantly associated with scores on the SF36v2 health survey. In addition, neither training nor the presence of type 2 diabetes significantly affected the physical or mental component scores on the QOL survey.
The Family Context of an Intervention to Prevent Type 2 Diabetes in High-Risk Teens
Authors: Seibold Esther S. , Knafl Kathleen , Grey Margaret
Published: April 2008

PURPOSE

This research describes the family context of eating and mealtime patterns in young adolescents at high risk for type 2 diabetes and the implications for preventing this disease.

METHODS

Ten families, each consisting of a child and one parent, participated in individual, semistructured interviews that focused on family eating patterns. Topics included meal schedules, food preparation, family eating patterns, school eating patterns, and perception of the child's weight. Interviews were audiotaped, transcribed verbatim, and analyzed using focused summaries and thematic analysis methods.

RESULTS

Four main themes were identified: child and family eating patterns, perspectives on obesity, perspectives on weight control, and health concerns. Family eating patterns were often inconsistent, and few healthy eating models were available at home or school. Obesity was not always seen as a negative factor, particularly by the youth. Weight-control efforts were sporadic, typically unsuccessful, and consisted primarily of intermittent increases in physical activity. Parents did not actively participate in their child's weight-control efforts.

CONCLUSIONS

Effective interventions for obesity and prevention of type 2 diabetes in youth should include parents in both cognitive and behavioral strategies.
Use of Cognitive Interviewing to Adapt Measurement Instruments for Low-Literate Hispanics
Authors: Rosal Mllagros C. , Carbone Elena T. , Goins Karin Valentine
Published: April 2008

PURPOSE

Cognitive interviewing techniques were used to adapt existing measures for use with a population of low-literate Spanish-speaking people with diabetes.

METHODS

Five individuals of Caribbean origin with diabetes participated in cognitive interviews for 4 instruments (measuring diabetes knowledge, quality of life, self-management, and depression) adapted for oral administration to low-literate individuals. Audiotaped interviews and handwritten notes were subjected to content analysis to identify problems across the 4 instruments as well as specific to a given instrument.

RESULTS

The following key problems were identified: general instructions were not helpful, items that were not specific enough generated a variety of interpretations, some wording was confusing, abstract concepts were difficult to understand, some terminology was unfamiliar, and interpretation of certain words was incorrect.

CONCLUSIONS

The data illustrate the usefulness of cognitive interviewing as a first step in the process of adapting measurement instruments.
Diabetic Retinopathy and Laser Photocoagulation: A Personal View
Authors: Breitenbach Ruth
Published: April 2008

When I awoke, I could see a large stream of blood flowing down the field of vision in my right eye. I immediately knew what it was. I had had many small hemorrhages before, but this time my fear was heightened. Although my vision was ini tially clear, in two hours there was total blurriness in that eye. When I tried to read the large "E" on the first line of the vision chart at the retinal clinic, I couldn't see it. My vision in the eye had gone from 20/20 to "nothing." I distinctly remember the words of the ophthalmologist ... "Now you can tell your patients what it is like to have a major retinal hemorrhage!"
Diabetes Teaching
Authors: Dries Linda , Dizzia Sophia
Published: April 2008

Recorded in studies by Nickerson (1972), Watkins (1967), and Liefson (1967); diabetic patients lack self- care knowledge. Prompted by these studies, 53 hospitalized diabetic patients received evaluation of selected knowledge before and after multidisciplined teaching. Collection of descriptive data included: age, sex, education, regulation method, family history of diabetes, and years with diabetes. Speaking and understanding English and not being critically ill were the only restrictions placed on the sample. Before and after teaching, a selected interviewer administered an identical questionnaire containing 22 open-end diabetic related question. Point valves for each question were predetermined and recordings were made of scores before and after teaching. Diabetic teaching included basic knowledge area; pathophysiology of diabetes, diet, medication, foot and skin care, hyper/hypoglycemia, urine testing, and control methods. The scores after teaching showed a significant increase of knowledge for all diabetic patients involved in this study.
A Game Format For Use In Patient Education
Authors: Rice Leslie
Published: April 2008

To review and evaluate what information patients had learned in a basic diabetes program, the authors developed a game format as an alternative to the usual pre- and post- test.
Education and Care of the Diabetic Patient on CAPD
Authors: Stephenson Elizabeth , Nordberg Trixi
Published: April 2008

Because continuous ambulatory peritoneal dialysis (CAPD) is becom ing widely used nurses should be aware of the indications and contrain dications for this mode of therapy. Ed ucation of these patients is extensive and involves not only the patient and family, but staff nurses, dietitians, house staff, and the diabetes nurse specialist. A case study demonstrates some of the problems.