bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Aerobic Exercise in Reducing Stress in Diabetic Patients
Authors: Vasterling Jennifer J. , Sementilli Mary Elizabeth , Burish Thomas G.
Published: April 2008

In addition to providing direct physical benefits to diabetic patients, aerobic exercise may also provide psychological benefits, including the reduction of stress. Stress reduction in diabetic patients may directly improve their quality of life as well as indirectly alter the course of their disease. This paper reviews a representative sample of studies that examined the effects of aerobic exercise on physiological and subjective responses to stress, and presents relevant clinical issues, including the minimization of potential risks, an exercise prescription, and suggestionsfor enhancing exercise adherence.
Beyond CME: Diabetes Education Field-Interactive Strategies from Sweden
Authors: Rosenthal Marilynnm. , Carlson Anita
Published: April 2008

The Diabetes Educational and Training Unit (DETU) at Karolinska Hospital is a permanent, continuing medical education unit working with general practitioners and nurse teams from Stockholm's neigh borhood health centers. It offers a two-week educational program four times a year, teaching a comprehensive approach to diabetes care. Evaluation research found that centers that had implemented the approach taught at the CME course had excellent staff rapport and produced patients who were more knowledgeable about their disease and better able to engage in self-care. As a result of this research, the Stockholm DETU has added innovative field- interactive strategies to stimulate centers that have not implemented the program. These strategies include techniques to enhance staff rapport, increase knowledge and interest in care for people with diabetes, and arrive at staff- determined approaches for organizing diabetes care. Initial evaluation of these strategies indicate encouraging results.
The Kentucky Diabetes Control Program and the Feasibility of the Pyramidal Model for Public Health Intervention in Diabetes Mellitus
Authors: Leichter Steven B. , Hernandez Carlos , Harvill Charlotte , Rice George , Gollmar Charles
Published: April 2008

The Kentucky Diabetes Control Program was the first statewide program to use an indirect, "pyramidal" model to achieve desired changes in health care delivery for diabetes. This model leverages the expertise of sub- specialists through regional sub specialty teams (RDTs) of allied health professionals to primary health professionals for use with their patients. It has the advantage of yielding geometric increases in the numbers of patients affected while utilizing the existing primary care system. The model was implemented throughout Kentucky over four years and now includes an admin istrative core, two subspecialty resource centers, and 18 RDTs, with a registered nurse and dietitian in each. During its first five years of operation, the program providedformal, continuing education in diabetes to 16, 035 health professionals. They, in turn, provided formal patient education to 20, 866 patients and family members. These results suggest the feasi bility of the indirect, pyramidal model as afunctional public health intervention in diabetes.
A Descriptive Study of How Clients Make Life-Style Changes
Authors: Wierenga Mary E. , Browning Jeanne M. , Mahn Joan L.
Published: April 2008

The purpose of this study was to identify and describe how adults with diabetes in a weight control study attempted to make life-style behavioral changes. All subjects had non-insulin-dependent diabetes mellitus (NIDDM) and were 20 % to 50 % overweight. Data were drawn from narrative responses given by 28 clients to open-ended questions regarding behavioral change. Questions were asked as part of a 16-week life-style behavioral change program for weight control. A systematic analysis of content was used to generate six categories of responses depicting the life-style behavioral change process. The process, as described by these clients, is: Starting point; Intro spection; Why change; Mental preparation; Plans, progress, and continuation; and Helps and hindrances.
Reducing Blood Glucose Variability by Use of Abdominal Insulin Injection Sites
Authors: Zehrer Cindy , Hansen Rebecca , Bantle John
Published: April 2008

Virtually all patients with type I diabetes are familiar with inexpli cable fluctuations in blood glucose concentration that expose them to both hypoglycemia and hyperglycemia. It is commonly assumed that such fluctuations are due, in large part, to varia tions in food intake, physical activities, and emotional state. However, substantial day-to-day variation in blood glucose concentration is observed when diet, exercise, emotional state, insulin dosage, and timing of insulin administration are held constant. This suggests that variation in the rate of absorption of insulin from the subcutaneous injection sites may be an important factor causing those fluctuations. Variations in insulin absorption are increased if the anatomic regions used for injec tions are rotated. A recent study completed at the University of Minnesota Hospital and Clinic indicates that it is inadvisable for type I diabetic subjects to rotate insulin injection regions; rather, insulin injections should be confined to a single anatomic region (usually the abdomen) as this will decrease day-to-day variability in blood glucose concentration. Such a decrease should allow greater precision in adjusting insulin doses, thereby helping achieve good control.
A Comparison of User Accuracy, Techniques, and Learning Time of Various Systems for Self Blood Glucose Monitoring
Authors: Tomky Donna M. , Clarke Dana H.
Published: April 2008

Accuracy of results of self blood glucose monitoring (SBGM) has been shown to be technique and user dependent. Thirty patients, using four commercially available meters (Accu-Chek II, Glucometer II, Glucoscan 2000, and ExacTech), were studied to test the relative accuracy, technique error rates, and learning time for the four meters. No significant difference was found in user accuracy among the four meters. The mean number of technique errors was significantly smaller with the ExacTech system compared with the other three. No significant changes in user accuracy were seen after 1 week of practice with unfamiliar meters. The authors conclude that while all meters had approximately the same user accuracy, the ExacTech meter, which required the least user technique, had fewer user errors and required less time to learn to use.
Weight Loss From Inappropriate Insulin Manipulation: An Eating Disorder Variant in an Adolescent With Insulin-Dependent Diabetes Mellitus
Authors: Bubb Jeanne A. , Pontious Sharon L.
Published: April 2008

This is the first in a series ofpapers being sponsored by the Psychosocial Committee ofAADE that will highlight psychosocial issues encountered in the treatment of diabetes. The present case describes the assessment, diagnosis, and treatment of a young woman with IDDM who inappropriately manipulated her insulin to lose weight. The discussion focuses on the role of the diabetes treatment team in the early detection and prevention of maladaptive weight-loss behaviors. This is achieved through routine assessment, diabetes-specific dietary counseling, and the education of young patients and their parents on the serious health and financial consequences of inappropriate insulin a adjustment.
Diabetes Care in Schools: Benefits and Pitfalls of Public Law 94-142
Authors: Gray Deborah L. , Golden Michael P. , Reiswerg Joseph Reis
Published: April 2008

The implementation of the Education forAll Handicapped Children Act of 1975 (Pub L No. 94- 142) has brought significant changes in educational services for health-impaired children. Health- related services are one of many important services available to children under Pub L No. 94-142. For some children with IDDM, specific diabetes-related care is essentialfor continued progress in school. However, barriers exist that impede access to related health support services, including lack of agreement about the applicability for Pub L No. 94-142 to children with IDDM, lack of consensus as to who should provide services, and concern about liability ofschool personnel. This paper describes those barriers and suggests approaches to overcome them. One such approach is an Indiana State legislative amendment that provides schools with immunity from civil liability for diabetes- related care.
Empowerment: An Idea Whose Time Has Come in Diabetes Education
Authors: Funnell Martha M. , Anderson Robert M. , Arnold Marilynn S. , Barr Patricia A. , Donnelly Michael , Johnson Patricia D. , Taylor-Moon Denise , White Neil H.
Published: April 2008

We have learned much in the past 10 years about how to help patients to acquire diabetes-related knowledge and skills and how to use strategies to help patients change behaviors. However, the application ofknowledge and techniques should be guided by a relevant, coherent, educational philosophy. Empowerment offers a practical conceptual framework for diabetes patient education. Empowering patients provides them with the knowledge, skills, and responsibility to effect change and has the potential to promote overall health and maximize the use of available resources. It is an idea whose time has come for diabetes education.
Impact of a Camp Experience on Choice of Coping Strategies by Adolescents With Insulin-Dependent Diabetes Mellitus
Authors: Smith Karen E. , Schreiner Barbara-Jo , Brouhard Ben H. , Travis Luther B.
Published: April 2008

Summer camps for children with IDDM have allowed educators to expand diabetes curricula and test novel approaches to education. Yet few evaluations have been published assessing the effectiveness of these types of educational interventions. The present study was designed as a formative assessment to provide preliminary evaluation of the impact of a life skills curriculum designed to increase awareness of different techniques that may be useful in managing stress. Life skills curricula are included each year as part of the teen session at the Texas Lions Camp for Children with Diabetes. Following the intervention, campers reported an intent to use more problem-focused and fewer detachment strategies to deal with a personally identified stressor. Limitations of the current pilot study are used to illustrate problems inherent in evaluation of camp programs.
Smoking, Cessation, and the Diabetes Health Care Team
Authors: Haire-Joshu Debra
Published: April 2008

Cigarette smoking is a major risk factor in diabetes and contributes to the development of microvascular and macrovascular complications. Despite this, approximately one third of patients with diabetes smoke. Nicotine is physically and psychologically addictive, with multiplefactors contributing to the initiation and continuation of the habit. Cessation is a process in which the smoker progresses through several stages of change, including precontemplation, contemplation, action, maintenance, and relapse. Knowledge of this process is needed for the diabetes health care team to effectively individualize smoking prevention and cessation strategies. This stepped care approach includes preventive, behavioral, and pharmacologic strategies as a component of routine diabetes education.
From Diagnosis to Home Management: Nutritional Considerations for Women With Gestational Diabetes
Authors: Armstrong Cynthia L. , Brown Linda P. , York Ruth , Robbins Deborah , Swank Anne
Published: April 2008

Each year 90,000 women in the United States are diagnosed with gestational diabetes. The transition from diagnosis to home management is a time of high stress for these women. Anxiety may lead to difficulty with self-care in general and the diabetic diet in particular. Follow-up education by a diabetes educator can help clients plan meals that comply with the nutritional meal plan without disrupting the family's eating habits. The client should be taught to measure portions, to recognize sugar as an ingredient in foods and medicines, and to deal with special occasions such as holiday meals, travel, and illness. If extended home care is not feasible, the creative diabetes educator will devise other educational opportunities, such as home videos, telephone support networks, special childbirth classes for women with gestational diabetes, and luncheon meetings at which nutritionally correct meals are served.
Euglycemic Control of Gestational Diabetes Mellitus by Specific Dietary Manipulation: A Case Study Presentation
Authors: Mahaffey Pamela J. , Podell Susan Kagen
Published: April 2008

Gestational diabetes is the most common complication of pregnancy. If maternal hyperglycemia is not well controlled, excess glucose is transmitted to the fetus, which can lead to fetal macrosomia and maternal and fetal complications. Dietary treatment for gestational diabetes varies among practitioners. A case review is presented of a 32-year--old white woman with gestational diabetes whose condition was complicated by her blood glucose intolerance to lactose in milk. By following a carefully monitored regimen using specific dietary manipulation to maintain normoglycemia, the woman was able to deliver a normal, healthy baby by spontaneous vaginal delivery.
Addressing Attitudes During Diabetes Education: Suggestions From Adult Education
Authors: Greene David S. , Beaudin Bart P. , Bryan Jean M.
Published: April 2008

Suggestions from adult education can improve the effectiveness of diabetes education programs. While information and knowledge are noted as important factors in diabetes education, the literature indicates that they are insufficient to insure improved treatment outcomes. Research suggests that addressing psychosocial variables can improve diabetes education effectiveness. Although there are a multitude of psychosocial variables, attitude is consistently identified as an important contributor to positive diabetes management. Practical suggestions from adult education are offered to improve the learner's attitude about diabetes, the learning process, and the instructor.
Understanding the Use of the Exchange Lists for Meal Planning in Diabetes Management
Authors: Holler Harold J.
Published: April 2008

The Exchange Lists for Meal Planning has been in existence since 1950 and was updated in 1976 and 1986. The lists were designed to provide a universal system for the nutrition management of diabetes mellitus. The current edition emphasizes a high-carbohydrate, low-fat diet and is widely used by persons with diabetes and by diabetes educators. To use the exchange lists, the educator must understand how to develop a meal plan. The meal plan serves as the tool to help patients select appropriate foods and amounts. The necessary steps for establishing the meal plan are outlined, and a suggested sequence for educating persons with diabetes in the use of the lists is presented.
Impact of Community-Based Diabetes Education on Program Attenders and Nonattenders
Authors: Irvine Audrey A. , Mitchell Christina M.
Published: April 2008

This study reports on the differential impact of a moderately intensive diabetes education program on program attenders and dropouts. Sixty-one individuals with diabetes mellitus participated in a diabetes education program to increase knowledge, self-care, and metabolic control. Program attenders demonstrated a significant increase in diabetes knowledge and foot care irrespective of whether they attended the control or education groups. A discriminant analysis suggested that the nonattenders were more poorly educated, had less income, were younger, had had diabetes twice as long, reported more barriers to self-care, and were in poorer health than attenders. These results suggest that patients who attend interventions may be able to benefit from even minimal levels of intervention, while program dropouts may need special assistance to overcome obstacles to program participation.
An Assessment of Computer Use, Knowledge, and Attitudes of Diabetes Educators
Authors: Anderson Robert M. , Donnelly Michael B. , Hess George E.
Published: April 2008

A questionnaire to survey attitudes, use, and knowledge of computers was sent to 816 randomly selected members of AADE to determine the degree to which currently available computer resources are used in diabetes education and to investigate the need for future computing resources designed to support diabetes education. Analysis of the data showed that even diabetes educators who use computers infrequently have a generally favorable attitude toward them. Highest use of computers is in noneducational applications, mostly for word processing and record keeping. Most respondents believe that computers have yet to make a major contribution to the teaching and learning process in diabetes education, and few felt adequately prepared for creative use or development of computer applications. Increasing the role of computers in support of patient education will require encouragement and demonstrations of computer efficacy from health care institutions and professional organizations.
Diabetes Aids and Products for People With Visual or Physical Impairment
Authors: Petzinger Ruth A.
Published: April 2008

Common complications of diabetes include visual impairment and problems with manual dexterity because of peripheral neuropathy. These conditions make diabetes self-care activities difficult unless techniques and equipment can be individually modified. To help diabetes educators and their clients locate aids and products to meet their special needs, this paper presents a compilation of aids and products and how and where to obtain them. A complete bibliography is included.
Perceived Effectiveness, Cost, and Availability of Patient Education Methods and Materials
Authors: Funnell Martha M. , Donnelly Michael B. , Anderson Robert M. , Johnson Patricia D. , Oh Mary S.
Published: April 2008

To determine the efficacy of and need for patient education methods and media, a needs assessment was sent to 816 members of the American Association of Diabetes Educators. Respondents (n=325, 40%) included 62% RNs, 36% RDs, 1% other; 62% CDEs. Their mean number of years experience in diabetes education was 8.5, and 99% routinely provided patient education. Respondents indicated that videotapes and slide tapes were the most educationally effective media and books and audiotapes were the least effective. Booklets and videotapes were the most cost-effective and computer-assisted instruction the least effective. While respondents perceived one-to-one counseling, skills training, and diabetes content sessions to be the three most educationally effective methods, support groups and large and small discussion groups were seen as the three most cost-effective educational methods. Among nine potential barriers to quality patient education listed, educators rated lack of third-party reimbursement as a major barrier most frequently and national availability of quality education materials as a barrier least frequently.
Self-Efficacy: Strategy for Enhancing Diabetes Self-Care
Authors: Hurley Ann C. , Shea Carole A.
Published: April 2008

This study found that the concept of self-efficacy was associated with diabetes self-care behaviors for individuals with complex insulin requirements. Individuals with higher levels of self-efficacy were better able to manage their diabetes self-care. Diabetes educators are encouraged to incorporate the self-efficacy concept into teaching programs to help individuals develop their own strategies for long-term management of their diabetes. The diabetes scales that made both concepts, self-efficacy and self-care, operational have content validity and measurement reliability and may be used in practice settings to obtain pretreatment information and to evaluate outcomes.
Hypoglycemia in Children With Insulin-Dependent Diabetes Mellitus
Authors: Puczynski Sandra , Puczynski Mark S. , Ryan Christopher M.
Published: April 2008

The promotion of normal growth and development and the avoidance of acute and long-term complications are overall goals in the management of a child with insulin-dependent diabetes mellitus. Recent studies provide new and pertinent information about the acute effects of hypoglycemia on such cognitive functioning as learning, memory, reading, and visuospatial skills. The effects of early onset diabetes on school performance are also discussed. This information should be incorporated by diabetes educators into the educational plan for children with IDDM, their families, and schools.
Evaluation of Diabetic Patients' Home Urine Glucose Testing Technique and Ability to Interpret Results
Authors: Smolowitz Janice L. , Zaldivar Andrea
Published: April 2008

The attention of diabetes educators has focused on home blood glucose monitoring, with little attention being given to the educational needs of patients who choose to perform home urine glucose monitoring. This study assessed patients' urine glucose testing technique and ability to interpret test results. A questionnaire was developed and administered by clinic nurses to 100 adults with diabetes who perform home urine glucose monitoring. Patients selected the urine testing product they used at home and demonstrated the technique using a prepared glucose solution. The nurse recorded whether patients correctly performed each step in the procedure according to product instructions. Results indicated that 61 % of patients did not perform the procedure correctly. Patients had difficulty reading package insert instructions, could not correctly read a clock, did not wait the correct amount of time before reading test results, and did not routinely keep written result diaries. This study demonstrates the importance of routine review of home urine glucose testing with the product used at home.
Adjusting Insulins
Authors: Albisser A. Michael , Sperlich Marianne
Published: April 2008

The teaching of effective insulin adjustment is a formal process that benefits from being carried out in a standardized way. The unique methods outlined in this report have been taught to people with diabetes for over 8 years. Iterative in nature, the methods are safe and work to achieve specified blood glucose or HbA 1c targets. They are designed to accommodate each individual's habits, recognizing that acceptance depends on adapting the medication to the life-style rather than vice versa. New technology was used to mediate insulin adjustments at home. Insulin adjustment of itself, however, is but one of five interdependent factors involved in successful self-management. These include (1) choosing sites of insulin injection; (2) choosing species of origin of insulins to be used; (3) reviewing life-style habits, including diet and exercise; (4) implementing dosage titration; and (5) follow-up. Lack of formalized insulin adjustment methods may be a major reason why many diabetes control programs fail to demonstrate significantly better metabolic control in their patients.
A Survey of Patient Preference for Insulin Jet Injectors Versus Needle and Syringe
Authors: Denne Jean R. , Andrews Katherine L. , Lees Donna V. , Mook William
Published: April 2008

Many studies have tested the insulin absorption rate and mechanical reliability of jet injectors. However, no published papers have dealt exclusively with patient preference for this method of administering insulin over a period of years. This paper reports the results of a survey done to determine if use of a jet injector for delivering insulin has an effect on acceptance of and adherence to a regimen of multiple doses of insulin. Over the past 15 years, the authors have instructed approximately 70 patients to use various jet injectors. A questionnaire was developed and sent to 75 patients. Of these, 42 completed and returned the questionnaire. Survey results indicate that even though some problems with the injectors were identified, 70% of those responding still preferred to take insulin by jet injector.
Comparison of First-Generation and Second-Generation Blood Glucose Meters for Use in a Hospital Setting
Authors: Meehan Carolyn D. , Bove Lisa Anne , Jennings Antnony S.
Published: April 2008

This study evaluated and compared a first- and a second-generation blood glucose meter for precision, accuracy, and user preference. Two separate capillary blood glucose fingersticks were performed on 25 outpatients and 60 inpatients with diabetes. Samples were drawn for serum glucose determinations immediately following the capillary fingersticks. Comparison of the Accu-Chek II and Satellite G meters in the outpatient setting gave results similar to the reference laboratory's. When the meters were tested on inpatients, the blood glucose results were significantly higher than those obtained from the hospital laboratory. The Accu-Chek II was more precise than the Satellite G on both normal and high blood glucose samples. Nursing staff indicated preference for the Satellite G because of its quick testing time but not for other preference factors surveyed. Both meters provided more accurate assessments of blood glucose concentration than were obtained from the serum glucose samples routinely processed by our hospital laboratory. Use of a nonfluorinated tube and delayed separation of the sample with resultant glycolysis likely account for this difference.
Effects of a Social Support Group, as an Adjunct to Diabetes Training, on Metabolic Control and Psychosocial Outcomes
Authors: Maxwell Annette E. , Hunt Isabelle F. , Bush Michael A.
Published: April 2008

The purpose of this present study was to evaluate a social support group as an adjunct to an intensive outpatient diabetes training program. Insulin-treated and non-insulin-treated patients (n=204) were randomized into two groups: the control group received the training program only, whereas the experimental group was offered the same program plus eight support group meetings. At the 7-month follow-up. patients in both groups showed improved metabolic control, diabetes knowledge, frequency of practicing recommended diabetes management behaviors. and emotional adjustment. Although no additional improvement was seen in those outcome measures in patients who attended support group meetings, results of a subjective evaluation of the support group showed that patients experienced positive feelings in the groups that may contribute to patient health. A better understanding of the possible contrihution of support groups to health is necessary before such groups are routinely recommended to patients.
Implications of Diabetes Mellitus and Periodontal Disease
Authors: Hallmon William W. , Mealey Brian L.
Published: April 2008

The dental profession is acutely aware of oral health problems associated with diabetes mellitus and clinical manifestations indicative of occult forms of the disease. Periodontal disease is common in patients with diabetes, and its effective management in diabetic patients requires cooperation involving the patient, physician, diabetes educator, dentist, and other allied health care providers. While these patients categorically appear more prone to diseases affecting the supporting tissues of the teeth, preservation of functional dental integrity can be attained by effective control of contributing systemic and local factors. This paper will discuss periodontal disease, its relationship to diabetes, proposed mechanisms of interaction, and management of periodontal disease in the diabetic patient.
Diabetes Health Beliefs, Self-Care Behaviors, and Glycemic Control Among Older Adults With Non-Insulin-Dependent Diabetes Mellitus
Authors: Polly Rhonda K.
Published: April 2008

This descriptive study examined the relationships between diabetes-specific health beliefs and adherence to the diabetes regimen and glycemic control in 102 older subjects with non-insulin-dependent diabetes mellitus. Health beliefs and self-care behaviors were assessed by self-report questionnaires. Glycemic control was assessed by HbA1c values. Perceived barriers to treatment were related to adherence, while perceived severity of disease was related to glycemic control. No significant associations were found between other health belief model subscales and adherence or glycemic control. Subjects not on diabetes medication had better glycemic control than those on medication. Subjects with more recently diagnosed diabetes also had better glycemic control. Practice and research attention should include older diabetic persons' perceived barriers to performing diabetes-specific self-care behaviors and perceived severity of the disease to identify potential health beliefs that may need to be altered for improving glycemic control.
A Review of Recent Events in the History of Diabetes Nutritional Care
Authors: Powers Margaret A.
Published: April 2008

This paper provides an historical documentation and discussion of events that have influenced diabetes nutritional management in recent years. Many factors have shaped the nutrition care that persons with diabetes receive today. Nutrition science research is part of the history, as are myriad discoveries, research, advanced technologies, and evolving health care systems. This review of the past four decades will contribute a perspective of how we have gotten to where we are today.
Diabetes Quality Assurance Checklist: Assessment of Inter-rater and Intra-rater Reliability
Authors: Wylie-Rosett Judith , Cypress Marjorie , Basch Charles
Published: April 2008

The Diabetes Quality Assurance (DQA) Checklist was developed to measure adherence to standards of diabetes care. Two raters simultaneously scored a convenience sample of 23 charts of patients with diabetes. These raters scored each chart again 5-7 weeks later. Data obtained were used to assess inter-rater and intra-rater reliability. Inter-rater reliability was estimated for basic assessment at Time 1 (r = 0.94, 95% CI 0.86-0.97) and at Time 2 (r = 0. 91, 95% CI 0.81-0.96); and for high-risk assessment at Time 1 (r = 0.88, 95% CI 0.73-0.95). Intra-rater reliability for the basic assessment was estimated for Reviewer 1 (r = 0.84, 95% CI 0.65-0.93) and for Reviewer 2 (r = 0.75, 95% CI 0.49-0.89); the high-risk estimate for Review I was 0.60 (95% CI 0.25-0.81) and for Reviewer 2 0.97 (95% CI 0.94-0.99). The DQA Checklist is useful for monitoring and assessing diabetes care.
Coping Strategies in People with Insulin-Dependent Diabetes Mellitus
Authors: Lundman Berit , Norberg A.
Published: April 2008

Interviews were conducted to elicit information about coping strategies and emotional outcome among 20 adults with insulin-dependent diabetes mellitus. Coping strategies were identified and related to emotional outcome and metabolic control. When the most prominent strategy for each individual was considered, five patterns emerged: expertise, active routinization, passive routinization, ambiguity, and emotion-based action. Coping strategies and their metabolic and emotional outcomes were interrelated in a complex way. The best emotional and metabolic outcomes were associated with problem-solving based on self-monitoring of blood glucose and sensitivity to body sensations, along with logical reasoning from factual and experiential knowledge.
The Effect of a Diabetes Education Program Incorporating Coping Skills Training on Emotional Well-Being and Diabetes Self-Efficacy
Authors: Rubin Richard R. , Peyrot Mark , Saudek Christopher D.
Published: April 2008

This study examines the effects on emotional well-being and diabetes-related competence of an intensive education program taught by a multidisciplinary staff, including mental health professionals who taught diabetes-specific coping skills. Ninety-one adults who participated in the program completed the entire research protocol and follow-ups at 6-months and 12-months. The study assessed depression, anxiety, self-esteem, and diabetes-specific knowledge and self-efficacy. Participants improved initially on all measures and maintained the improvements at 1-year follow-up on measures of anxiety, self-esteem, and diabetes-specific knowledge and self-efficacy The implications of these findings for the design of educational interventions are discussed.
The Actual and Self-Perceived Knowledge of Diabetes Among Staff Nurses
Authors: Gossain Ved V. , Bowman Karen A. , Rovner David R.
Published: April 2008

The actual and self-perceived knowledge of diabetes among staff nurses was evaluated utilizing previously validated and standardized instruments. One hundred twenty-seven staff nurses employed at three university-affiliated community hospitals participated in the study. Actual knowledge was assessed by the Diabetes Basic Knowledge Test (DBKT) and self-perceived knowledge was assessed by the Diabetes Self-Report Tool (DSRT). There was a direct relationship between self-perceived knowledge and number of correct responses on the DBKT. Nurses with a higher level of education performed better than those with fewer years of education. Nurses with fewer years of experience did better than those with greater years of experience. Although some areas of knowledge deficit were identified, we concluded that staff nurses employed at community hospitals are fairly competent in the field of diabetes and have a realistic perception of their knowledge deficiencies. Based on these findings, we believe that it should be possible to design in-service and continuing education programs for nurses to further improve their knowledge in the field of diabetes.
Professional Development
Authors: Cleary Margaret E.
Published: April 2008

The purpose of this department is to pro vide our readers with a forum to share ideas, insights, and individual expertise in a broad range of categories relating to pro fessional develpment and growth. Authors are invited to submit manuscripts that ad dress specific strategies and/or practical approaches relating to the responsibilities of the diabetes health care professional. Pa pers that creatively apply business. market ing, human resource development, leadership, and management skills to dia betes education are of particular interest. Manuscripts should be limited to 8 to 10 double-spaced pages and sent to Profes sional Development editor Gail A. D 'Eramo-Melkus, EdD, RN, Yale Univer sity School ofNursing, 25 Park St, PO Box 9740, New Haven, CT06536-0740.
Diabetes and Job Performance: An Empirical Investigation
Authors: Greene David S. , Geroy Gary D.
Published: April 2008

There are approximately 11 million people in the United States with diabetes, and the numbers are increasing by 6% annually. Still, the relationship between diabetes and job performance remains unclear and marked by bias. To help clarify this relationship, a multicriterion job-performance rating scale was developed to rate task behaviors, interpersonal behaviors, dowr-time behaviors, and hazardous behaviors.

A volunteer sample of 53 subjects was selected from people with insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). All subjects were rated individually by a supervisor; who also rated the norm for the work group. The norm rating was used to determine a norm-referenced control group.

The subjects were rated better than the norm in all categories and on all criteria: composite job performance (P<.001), task behaviors (P<.01), interpersonal behaviors (P<.01), down-time behaviors (P<.05), and hazardous behaviors (P<.001).
A Review of the Effects of Resistance Training for Individuals with Diabetes Mellitus
Authors: Soukup Jeffrey T. , Kovaleski John E.
Published: April 2008

Although the effectiveness of exercise as a treatment modality for the management of diabetes mellitus has long been recognized, a vital component of the exercise prescription has been overlooked. In addition to endurance training, resistance training may provide physiologic benefits to the individual with diabetes that, in some cases, may equal or exceed those gained through aerobic training. These benefits may include improved blood lipid profiles, increased absolute left ventricular wall contractility, decreased resting blood pressure, improved insulin sensitivity and glucose tolerance, improved glycemic control, improved muscular strength and endurance, and increased bone and connective tissue strength. By utilizing a combination of aerobic and resistance training, the individual with diabetes experiences a more comprehensive exercise program that can improve most areas of health and physical fitness. In addition, having a greater number of exercise modality options may enhance exercise compliance.
Non-Insulin-Dependent Diabetes and Obesity in the Black and Hispanic Population: Culturally Sensitive Management
Authors: Raymond Nicole R. , D'Eramo-Melkus Gail
Published: April 2008

The prevalence of diabetes is considerably higher among ethnic minorities, particularly black and Hispanic Americans, than in the nonminority white population. Obesity, a significant risk factor for non-insulin-dependent diabetes mellitus (NIDDM), also is more common in these ethnic groups. Because the combined effects of obesity and NIDDM can lead to potentially serious complications, overweight patients with NIDDM must be treated aggressively. However, effective treatment of these ethnic groups requires a sensitivity to and recognition of their unique cultural values. Diabetes educators and health care providers need to take into account specific ethnic beliefs, customs, food patterns, and health care practices, with the goal of incorporating these cultural factors into a practical and beneficial treatment regimen.
Revisiting Nurse Knowledge About Diabetes: An Update and Implications for Practice
Authors: Jayne Rael , Rankin Sally H.
Published: April 2008

This study attempted to ascertain the diabetes knowledge level of nurses in a university medical center, to describe correlates of nurse knowledge, and to compare levels of diabetes knowledge between nursing units. A convenience sample of staff nurses (n=99) from six inpatient units and an ambulatory care center volunteered to complete a previously developed, 45-item questionnaire testing their knowledge of basic concepts about diabetes mellitus.

Analysis of variance, comparing the nursing units, indicated a significant difference between units (P=.04) on the knowledge questionnaire. In a 4-step, hierarchial, multiple regression analysis, variables related to how competent the nurses felt in caring for diabetic patients and the number of diabetic patients cared for in the past month explained 28% of the variance in diabetes knowledge. Although this study corroborates earlier findings, questions still remain concerning the general adequacy of nurses' knowledge about diabetes.
Assessing the Diabetic Foot: Plantar Callus and Pressure Sensation
Authors: Collier Joann H. , Brodbeck Carol A.
Published: April 2008

The purpose of this study was to explore the relationship between the loss of protective pressure sensation in the foot and the formation of plantar calluses, two well-known precursors of plantar ulceration, in adults with diabetes referred to an outpatient diabetes education program. Pressure sensation testing was perforrned using Semmes-Weinstein monofilaments. Foot inspection included the identification and measurement of plantar calluses. Using the Wilcoxon Rank Sum test, groups categorized as sensitive (n=67) and insensitive (n=35) were compared on callus formation. The groups had equivalent numbers, areas, and thickness of calluses. The high prevalence of calluses in both sensitive and insensitive groups suggests that additional factors such as age-related changes in the foot and routine footwear must be included in risk assessment of the diabetic foot and in consideration of preventive interventions.
The Impact of the Trial Coordinator in the Diabetes Control and Complications Trial (DCCT)
Authors: Ahern Joann , Grove Nancy , Strand Trudy , Wesche Jacqueline , Seibert Carolyn , Brenneman Anne T. , Tamborlane William V.
Published: April 2008

The Diabetes Control and Complications Trial (DCCT) is a multicenter, randomized clinical trial studying the effects of two different diabetes regimens on the development and progression of early vascular complications in persons with insulin-dependent diabetes mellitus (IDDM). All of the centers have a Trial Coordinator. We administered a self-report questionnaire to each center to document the different activities for which the Trial Coordinator assumed responsibility, in successfully orchestrating the trial.

All Trial Coordinators were responsible primarily for recruitment, screening, medical management, education and training, and adherence and administration. Although documentation indicated that the Trial Coordinator was responsible for all of the above activities, the original applications reflected that very few of the Principal Investigators anticipated such a wide variety of duties. A Trial Coordinator was named in only 13 of the 21 applications and of these, only 6 actually assumed the position.

This study points out the need to develop a means to define characteristics, background, and training appropriate for candidates for a Trial Coordinator position in future studies.
Third-Party Reimbursement for Home Care of Clients with Diabetes
Authors: Milone-Nuzzo Paula F.
Published: April 2008

Home health care has increasingly become an integral component of the health care continuum for clients. The concept of providing care to a client in the home setting seems relatively straightforward. What has grown increasingly complex is the reimbursement structure under which services are provided. Adding to the complexity are the frequent changes in the regulations that govern the reimbursement for home care. This paper describes the current state of the third-party regulations that govern the reimbursement for the client with diabetes receiving home care.
Nursing Case Management: An Innovative Model of Care for Hospitalized Patients with Diabetes
Authors: Edelstein Eiaine L. , Cesta Toni G.
Published: April 2008

Cost, access, and quality are among the most pressing concerns facing the delivery of health care services in the 1990s. These issues are of particular concern for individuals with diabetes because of their high consumption level of health care resources. The purpose of this study was to evaluate whether a managed care approach could reduce the hospital stay while creating a balance between cost and quality of care.
Identifying and Treating Common and Uncommon Infections in the Patient with Diabetes
Authors: Garrison Mark W. , Campbell R. Keith
Published: April 2008

Patients with diabetes represent a unique group of individuals who appear more prone than others to developing infections. Several mechanisms have been proposed to explain the association between diabetes and infections. However, few conclusive studies exist and considerable debate continues regarding evidence for this predisposition. Despite this lack of documented proof, many health care practioners acknowledge that a number of infections are overrepresented in patients with diabetes. Some of these infections appear to occur exclusively in patients with diabetes, especially patients who are poorly controlled.

The presenting clinical features, causative organisms, and preferred treatment approaches will be discussed in this article for a variety of common and uncommon infections observed in patients with diabetes. In addition, the proposed predisposing factors will be addressed briefly
An Inpatient Diabetes Educator's Impact on Length of Hospital Stay
Authors: Feddersen Ellie , Lockwood Dean H.
Published: April 2008

This study assessed the impact of an inpatient diabetes education program on: 1) staff nurses' and patients' knowledge about diabetes, 2) hospital length of stay, and 3) patients'glycemic control. Over the course of 1 year, a certified diabetes educator updated nursing staff about diabetes care and education and coordinated a diabetes education program on two experimental medical units. Length of stay of insuliti-requiritig patients with diabetes and their diabetes knowledge and glycemic control were compared with two control medical units that received no structured diabetes education program. Results showed a significant difference in length of stay and patient knowledge between experimental and control units. Three conditions commonly associated with diabetes (diabetic ketoacidosis, osteomyelitis, foot ulcer) did not account for this difference in length of stay. There was no significant difference between the groups in glycemic control following discharge. While all groups showed improvement in their glycosylated hemoglobin values, only the change in the values of the total population and the control groups was significant. The findings suggest that a Certified Diabetes Educator can decrease length of stay in the hospital setting.
Modeling The Effect of Diabetes Education on Glycemic Control
Authors: Peyrot Mark , Rubin Richard R.
Published: April 2008

The objective of this study was to identify the mechanisms by which diabetes education improves glycemic control. Study participants were 82 adult patients from a comprehensive outpatient diabetes education program who completed a research protocol at the outset of the program and again 6 to 12 months later. The research protocol included a glycosylated hemoglobin assay and self-reported frequency of two insulin administration events (shot skipping and dosage adjustment), self-monitoring of blood glucose (SMBG), and exercise. Those who did not improve any aspect of self-care reduced their mean glycohernoglobin frorn 9.7 to 9.0. Those who improved exercise or SMBG (but not both) reduced their glycohemoglobirt from 10.9 to 9.6. Those who improved both exercise and SMBG and those who improved insulin adntinistratiort had the lat-gest irttprovemertt in glycemic control, from 12.5 to 9.6. These findings suggest that if diabetes education can help patients improve self-care behanior, it cart bring about dramatic improvements in glycentic control. Improved insulin administration is the single most powerful way to improve glycemia, but improving other aspects of self-care also can produce substantial gains.
Measuring Attitudes and Health Beliefs Among Mexican Americans With Diabetes
Authors: Schwab Terri , Meyer Julie , Merrell Rosa
Published: April 2008

Adherence to the treatment regimen for patients with diabetes is of major concern to healthcare practitioners, particularly when dealing with the high-risk, low-income, Mexican-American population. Assessing the attitudes and beliefs of this group is vital for planning effective and realistic intervention strategies. Therefore, we designed a culturally sensitive instrument to measure health beliefs and attitudes of low-income Mexican Americans with diabetes. The Health Belief Model (HBM) was used as a basis for this study because it is well accepted as a predictor of health-related behaviors. However, we found that the HBM was not an effective tool for assessing the health beliefs or attitudes of this patient population even after rigorous efforts to operationalize the HBM and after conducting extensive statistical analyses. Only two of the five subscales of the traditional HBM, barriers and benefits, were reliable. Scales to measure acculturation and fatalism were added to increase the cultural sensitivity of the tool. These added components were found to be an important variable in interpreting the results for low-income Mexican-American patients.