bluuebunny/crossref_metadata_2025 huggingface dataset:
New Era in Drug Interaction Evaluation: US Food and Drug Administration Update on CYP Enzymes, Transporters, and the Guidance Process
Authors: Huang Shiew‐Mei , Strong John M. , Zhang Lei , Reynolds Kellie S. , Nallani Srikanth , Temple Robert , Abraham Sophia , Habet Sayed Al , Baweja Raman K. , Burckart Gilbert J. , Chung Sang , Colangelo Philip , Frucht David , Green Martin D. , Hepp Paul , Karnaukhova Elena , Ko Hon‐Sum , Lee Jang‐Ik , Marroum Patrick J. , Norden Janet M. , Qiu Wei , Rahman Atiqur , Sobel Solomon , Stifano Toni , Thummel Kenneth , Wei Xiao‐Xiong , Yasuda Sally , Zheng Jenny H. , Zhao Hong , Lesko Lawrence J.
Published: April 2008

Predicting clinically significant drug interactions during drug development is a challenge for the pharmaceutical industry and regulatory agencies. Since the publication of the US Food and Drug Administration's (FDA's) first in vitro and in vivo drug interaction guidance documents in 1997 and 1999, researchers and clinicians have gained a better understanding of drug interactions. This knowledge has enabled the FDA and the industry to progress and begin to overcome these challenges. The FDA has continued its efforts to evaluate methodologies to study drug interactions and communicate recommendations regarding the conduct of drug interaction studies, particularly for CYP‐based and transporter‐based drug interactions, to the pharmaceutical industry. A drug interaction Web site was established to document the FDA's current understanding of drug interactions (http:www.fda.govcderdrugdrugInteractionsdefault.htm). This report provides an overview of the evolution of the drug interaction guidances, includes a synopsis of the steps taken by the FDA to revise the original drug interaction guidance documents, and summarizes and highlights updated sections in the current guidance document, Drug Interaction Studies—Study Design, Data Analysis, and Implications for Dosing and Labeling.
Development and Evaluation of an Intervention Program: "Control on Campus"
Authors: Wdowik Melissa J. , Kendall Patricia A. , Harris Mary A. , Keim Kathryn S.
Published: April 2008

PURPOSE

This study was designed to develop and test an intervention for college students with type 1 diabetes.

METHODS

A diabetes program, "Control on Campus," and guide were developed based on the Expanded Health Belief Model and Social Learning Theory. Diabetes knowledge, attitudes, and behaviors were assessed preprogram, postprogram, and at follow-up for 3 intervention cohorts and a control group.

RESULTS

Reporting of HbAlc values and diabetes knowledge improved significantly as a result of the intervention compared with no increase in the control group. Furthermore, participants reported feeling more support on campus after the intervention, appeared to have overcome their fears associated with testing their blood glucose, reported an increased frequency of blood glucose testing, and were more likely to test when they felt their blood glucose level was low.

CONCLUSIONS

Overall, this research yielded substantial insight into the characteristics of college students with diabetes and was successful in designing and evaluating an intervention trial for this population.
Coping and Psychosocial Adjustment of Women With Diabetes
Authors: Willoughby Deborah F. , Kee Carolyn C. , Demi Alice , Parker Veronica
Published: April 2008

PURPOSE

The purpose of this study was to investigate relationships between coping styles and psychosocial adjustment for women with diabetes.

METHODS

The sample consisted of 115 community-residing women with diabetes. Coping was measured by the Revised Jalowiec Coping Scale and psychosocial adjustment by the Psychosocial Adjustment to Illness Scale. Pearson's product moment correlation was used to assess relationships between coping and adjustment.

RESULTS

The most frequently and effectively used coping styles were optimistic, confrontive, self-reliant, and supportant. The psychological, social, and health care domains showed the most problems; the fewest were in the extended family, sexual, and vocational domains. Relationships were found between women's coping styles and psychosocial adjustment, with better adjustment associated with effective use of confrontive, supportant, optimistic, self-reliant, and palliative coping styles.

CONCLUSIONS

Important relationships exist between the ways women cope with diabetes and their level of psychosocial adjustment to the illness. Knowledge of these relationships can help diabetes educators assist clients in making lifestyle changes.
A Community Diabetes Education and Gardening Project to Improve Diabetes Care in a Northwest American Indian Tribe
Authors: Armstrong Donna L.
Published: April 2008

PURPOSE

The purpose of this study was to design a culturally appropriate education program for a Northwest American Indian tribe.

METHODS

Needs assessment revealed that a community approach rather than clinic-based education would address multiple barriers to diabetes care. Both process and outcome information are described for community and individual level evaluations.

RESULTS

This intervention design consisted of community diabetes workshops called "How Healthy Am I?--Treating the Whole Person." The workshops represented a traditional view of health and included 4 specific themes: (1) taking care of the body, with an emphasis on diabetes care and physical activity; (2) mental health needs; (3) foods for healthy living; and (4) spirituality and healing the whole person. Workshops were designed to be social and informational, and involve all community members. A community garden was established to improve access to fresh produce and encourage exercise.

CONCLUSIONS

Prior to implementation of the community workshops and evaluations, the tribal government chose to discontinue receiving the federal funding for this project. Elements of a mutually respectful collaboration are outlined and discussed based on the experiences of this project.
Diabetes in Urban African Americans: Assessment of Diabetes-Specific Locus of Control in Patients With Type 2 Diabetes
Authors: Hayes Risa P. , Bernard Annette M. , Slocum Wrenn , EI-Kebbi Imad , Ziemer David , Gallina Daniel , Phillips Lawrence S.
Published: April 2008

PURPOSE

This study was conducted to examine the applicability and relationship to glycemic control of the Diabetes Locus of Control (DLC) Scales in a low-literacy, economically deprived, African American population with type 2 diabetes.

METHODS

The DLC Scales were administered orally to African American patients with type 2 diabetes who had been referred to the diabetes unit of a large urban public hospital. Reliability, interscale correlations, and associations with patient characteristics were compared with those originally obtained for a better educated, predominately Caucasian population.

RESULTS

The structure and correlates of the DLC Scales in the African American population were more similar than different from those originally obtained from a primarily well-educated, Caucasian population. However, comprehension of some items was difficult for up to 10% of the low-literacy population. A significant relationship was found between belief in chance and both glycemic control at the 6-month follow-up and the change in glycemic control over time.

CONCLUSIONS

Although the DLC Scales operate similarly in an urban African American population with limited education, further modification is needed to enhance the prediction of glycemic control and provide direction for developing targeted interventions.
Assessing the Cultural Relevance of an Education Program for Urban African Americans With Diabetes
Authors: Anderson Robert M. , Funnell Martha M. , Arnold Marilynn S. , Barr Patricia A. , Edwards Gloria J. , Fitzgerald James T.
Published: April 2008

PURPOSE

This study was conducted to assess the cultural relevance of an education program for urban African Americans with diabetes.

METHODS

A set of 12 videotape vignettes were developed for use in diabetes education for urban African Americans with diabetes. Focus groups and questionnaires were used to determine if patients and diabetes educators would find the materials stimulating, culturally appropriate, and useful.

RESULTS

The videotape and discussion guide were perceived as valuable by both healthcare professionals and patients.

CONCLUSIONS

This education program could be a valuable resource for diabetes educators who want to provide culturally sensitive and relevant diabetes education for urban African Americans with diabetes.
Health-Promotion Practices of Young Black Women at Risk for Diabetes
Authors: Jefferson Vanessa W. , Melkus Gail D. , Spollett Geralyn R.
Published: April 2008

PURPOSE

The purpose of this study was to assess the health-promoting practices of young black women at risk for type 2 diabetes.

METHODS

The sample consisted of 30 black women from an urban area who had a history of gestational diabetes and/or a first-degree relative with diabetes. Participants completed the Health-Promoting Lifestyle Profile II Survey and an interview. Both were used to categorize health-promoting practices, exercise, diet, knowledge of diabetes prevention, and general health.

RESULTS

Demographic information and interview revealed a propensity towards obesity, despite education and income levels. The results for the Lifestyle II Survey showed a higher average total score for healthy nutrition than physical activity, which were inconsistent with the qualitative data obtained by interview. Fifty percent stated that they exercised as a general health-promoting behavior. Self-reported daily caloric, fiber, and fat intake was high to moderate; 60% reported initiating diet modifications secondary to a desire to lose weight or for medical problems; and 26% reported receiving information on diabetes prevention from a healthcare provider.

CONCLUSIONS

A systematic approach of planning and actively incorporating health-promoting activities into one's lifestyle as a young adult may protect or delay the onset of diabetes and prevent complications.
Gender and Treatment Differences in Knowledge, Health Beliefs, and Metabolic Control in Mexican Americans With Type 2 Diabetes
Authors: Brown Sharon A. , Harrist Ronald B. , Villagomez Evangelina T. , Segura Mario , Barton Sara A. , Hanis Craig L.
Published: April 2008

PURPOSE

The purpose of this project was to describe metabolic control, knowledge, and health beliefs of Mexican Americans with type 2 diabetes.

METHODS

The study site was Starr County, Texas, a border community located on the Rio Grande River and bordering northern Mexico. Of the total sample of 360 persons, 252 agreed to participate in this intervention study and were randomized either to the treatment group or the control group that waited 1 year to begin the intervention.

RESULTS

The majority of individuals were Spanish-speaking females with a mean age of 54 years and a mean diabetes duration of 8 years. For those treated with diet only, males exhibited higher fasting blood glucose levels than females. Gender effects were seen for cholesterol level, with females exhibiting higher levels than males. Males expressed stronger perceptions of control and social support for diet. Bivariate relationships were found between acculturation and diabetes knowledge. The health belief subscales of control and impact on job together explained 16% of the variance in HbAlc values.

CONCLUSIONS

Males and females held differing beliefs about ability to control their diabetes and degree of social support for diet. The impact of gender differences on ability to integrate diabetes self-care and on effectiveness of diabetes programs has not been determined but should be considered in future research.
Developing a Conceptual Framework for Understanding Illness and Attitudes in Older, Urban African Americans With Diabetes
Authors: Chin Marshall H. , Polonsky Tamar S. , Thomas Valencia D. , Nerney Michael P.
Published: April 2008

PURPOSE

This study was conducted to better understand how older African Americans with diabetes view their illness, and to develop a conceptual framework for approaching their care.

METHODS

Researchers conducted interviews of 19 African American patients 65 years or older who attended clinics at an urban academic medical center. The mean age of the patients was 73 years, 58% were female, 63% had a complication from diabetes, and 58% were taking insulin. Patients were asked open-ended questions about how diabetes affected their lives and their attitudes toward treatment. Data were analyzed through a grounded-theory perspective.

RESULTS

Patients showed variation in the degree to which they believed that diabetes affected their lives and how aggressive they wished treatment to be. Themes included issues of quality of life, health beliefs, and the social context. Paradoxical, contradictory statements were common, expressing ambivalence and uncertainty regarding the effect of the illness and the treatment.

CONCLUSIONS

Wide variation exists in the attitudes of older African Americans toward their diabetes and treatment. Patients frequently expressed ambivalence toward the care of their illness. Providers should explore these issues and help patients resolve their ambivalence if patient preferences are to be respected in the overall treatment plan.
How Diabetes Specialists Treat Their Own Diabetes: Findings From a Study of the AADE and ADA Membership
Authors: Graff Marilyn R. , Rubin Richard R. , Walker Elizabeth A.
Published: April 2008

PURPOSE

The purpose of this study was to determine how diabetes specialists, who themselves have diabetes, manage their own care.

METHODS

An independent research organization faxed anonymous, 1-page surveys to all professional members of the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) who had valid fax numbers. Only those individuals with diabetes were asked to fill out and return the survey.

RESULTS

Of the 12 525 surveys that were distributed, 802 (6.4%) were returned. The prevalence of type 1 diabetes in this sample was estimated to be 13 times higher than in the general US population, whereas the prevalence of type 2 diabetes was 42% to 54% lower. Of the respondents with type 1 diabetes, most (96%) practiced intensive treatment regimens, and more than half used an insulin infusion pump.

CONCLUSIONS

Diabetes specialists treat their own diabetes according to current standards of medical care, with insulin pumps being the preferred method of insulin therapy for type 1 diabetes in this sample. Knowing that experts almost universally practice intensive treatment regimens may be a powerful motivator for patients and sends a strong message to primary care providers and payers regarding the need for treating diabetes according to current standards of care.
Comparison of Pregnancy Mood Profiles in Gestational Diabetes and Preexisting Diabetes
Authors: Langer Niell , Langer Oded
Published: April 2008

PURPOSE

This study sought to answer the following questions: How does intensified diabetes management affect the patient's mood profile? Is there a relationship between levels of glycemic control and emotional profile? Which factors distinguish the emotional profile of women with pregestational diabetes from women with newly diagnosed gestational diabetes?

METHODS

A secondary analysis was conducted of women with newly diagnosed gestational diabetes (GDM), pregestational diabetes (PGDM), and nondiabetic controls. Those with diabetes were treated with an intensified approach. All participants responded to a questionnaire measuring bipolar subjective mood states. The relation between diabetes types, glucose characteristics during pregnancy, and mood were analyzed.

RESULTS

The mood profile was significantly associated with level of glycemic control in GDM women (comparable to controls). PGDM women were not affected by either level of glycemic control or diabetes class categories. The number of glucose determinations, marital status, and maternal age were related to mood profile for GDM women. CONCLUSIONS Because women with GDM and PGDM present different mood profiles in pregnancy, customized medical/behavioral goals may be needed to enhance compliance and optimize perinatal outcome.
Challenges to Participating in a Lifestyle Intervention Program: The Native American Diabetes Project
Authors: Griffin Julie A. , Gilhiland Susan S. , Perez Georgia , Upson Dona , Carter Janette S.
Published: April 2008

PURPOSE

This paper describes the factors that American Indian teachers in the Native American Diabetes Project (NADP) reported affected participation in the NADP lifestyle education sessions.

METHODS

A postsession exit interview was conducted with each of the 7 mentors (teachers) of the NADP sessions. Interview questions addressed general perceptions of the sessions, factors that kept participants from coming to the sessions, and attitudes toward diabetes and persons with diabetes. Interviews were transcribed and responses reflecting factors related to participation were marked and organized into topic areas.

RESULTS

Mentors reported a range of factors that affected participation in the sessions, such as conflicts with community activities and beliefs/attitudes about diabetes. The latter factor includes program knowledge, recruitment methods, attitudes toward the program, and beliefs about diabetes.

CONCLUSIONS

Asking community members what factors they believe affect participation is an important component of increasing participation in community-based programs. Community members can provide a valuable personal perspective of actual and potential conflicts in the community.
Secondary Analysis of Perceptions and Meanings of Type 2 Diabetes Among Mexican American Women
Authors: Aloozer Francesca
Published: April 2008

PURPOSE

the purpose of this study was to explore explanatory models of diabetes from the perspective of Mexican American women with type 2 diabetes.

METHODS

In-depth interviews were conducted in a secondary analysis of an interpretive interactionism study to investigate the meanings of diabetes from the perspectives of Mexican American women with type 2 diabetes. The sensitizing concept used was Kleinman's explanatory models of illness. The original study sample included 20 Mexican American women between the ages of 27 and 45 with varying lengths of time since diagnosis.

RESULTS

Data analysis was an interactive process. The data were collapsed into explanatory models of diabetes categorized as defining, getting, having, describing, or taking care of diabetes. The meaning of having diabetes was viewed as a life threat with complications and a shortened life.

CONCLUSIONS

Diabetes complications, viewed as symptoms, were structured in the explanatory models developed from the contextual arenas of family and community. Given the family and community history of diabetes, genetic predisposition to the disease, and perceived life threat, understanding Mexican American women's explanatory models about diabetes serves as a basis for negotiating therapeutic interventions.
A Diabetes Management Program for African American Women With Type 2 Diabetes
Authors: Keyserllng Thomas C. , Ammerman Alice S. , Samuel-Hodge Carmen D. , Ingram Allyson F. , Skelly Anne H. , Elasy Tom A. , Johnston Larry F. , Cole Anne S. , Henriquez-Rolddn Carlos F.
Published: April 2008

PURPOSE

this paper describes a clinic and community-based diabetes intervention program designed to improve dietary, physical activity, and self-care behaviors of older African American women with type 2 diabetes. It also describes the study to evaluate this program and baseline characteristics of participants.

METHODS

The New Leaf... Choices for Healthy Living With Diabetes program consists of 4 clinic-based health counselor visits, a community intervention with 12 monthly phone calls from peer counselors, and 3 group sessions. A randomized, controlled trial to evaluate the effectiveness of this intervention is described.

RESULTS

Seventeen focus groups of African American women were used to assessed the cultural relevance/acceptability of the intervention and measurement instruments. For the randomized trial, 200 African American women with type 2 diabetes were recruited from 7 practices in central North Carolina. Mean age was 59, mean diabetes duration was 10 years, and participants were markedly overweight and physically inactive.

CONCLUSIONS

Participants found this program to be culturally relevant and acceptable. Its effects on diet, physical activity, and self-care behaviors will be assessed in a randomized trial.
Who Participates in Internet-Based Self-Management Programs? A Study Among Novice Computer Users in a Primary Care Setting
Authors: Fell Edward G. , Glasgow Russell E. , Boles Shawn , McKay H. Garth
Published: April 2008

PURPOSE

the purpose of this study was to evaluate the participation rates and factors associated with nonparticipation among primary care patients who were invited to join an Internet-based self-management research program.

METHODS

Primary care providers invited their patients with type 2 diabetes to participate in an Internet-based diabetes self-management support program. Research staff contacted these patients by phone to assess their eligibility and interest in participating. Reasons for declining were assessed and demographic/medical status information was collected.

RESULTS

Of the eligible patients, 60% participated in the program. No significant differences were found between participants and decliners in gender, insulin use, computer familiarity, or computer ownership. There were significant differences in age and years since diagnosis. Participants were slightly younger and had diabetes for a fewer number of years than nonparticipants. Nonparticipation was not related to computer or Internet issues.

CONCLUSIONS

Most older diabetes patients without previous Internet experience will-takepart in Internet-based self-managment support programs if barriers to participation are addressed.
An Integrative Literature Review of Cardiac Risk Factor Management in Diabetes Education Interventions
Authors: Lacey Kimberly O. , Chyun Deborah A. , Grey Margaret
Published: April 2008

PURPOSE

the purposes of this paper are to (1) review the literature on educational interventions for adults with type 2 diabetes; (2) determine what kinds of interventions have been studied; (3) identify which interventions have included cardiac risk factor management; (4) determine how effective these interventions have been on metabolic control, diabetes-related outcomes, and cardiovascular-related outcomes; and (5) make recommendations for further research on combined interventions designed to promote optimal diabetes and cardiac risk factor management in adults with type 2 diabetes.

METHODS

Using an integrative literature review approach, 64 studies on diabetes education interventions for adults with diabetes published between 1987 and 1998 were reviewed; 44 met these criteria.

RESULTS

Few studies included cardiac risk factor management, which should be an integral part of diabetes management. Most studies demonstrated a beneficial effect of education on the management of type 2 diabetes but not cardiovascular risk.

CONCLUSIONS

Identifying strategies that promote effective disease management for improved diabetes control and reduction of cardiac events in adults with diabetes is essential. Further intervention studies focusing on the combined management of diabetes and cardiac risk factors are warranted.
Using a Primary Nurse Manager to Implement DCCT Recommendations in a Large Pediatric Program
Authors: Ahern Jo Ann , Ramchandani Neesha , Cooper Jake , Himmel Allison , Silver David , Tamborlane William V.
Published: April 2008

PURPOSE

this study was conducted to determine whether recommendations from the Diabetes Control and Complications Trial (DCCT) could be implemented in a large pediatric population using a diabetes clinical nurse specialist program coordinator dedicated to intensive management.

METHODS

Patients' charts were reviewed to examine HbAic levels from before the results of the DCCT were published and again 1 year after the recommendations were implemented. Patients who met the following criteria (N=124) were enrolled: type 1 diabetes, less than 18 years old, followed at Yale for 1 year prior to the results of the DCCT and 1 year after, and HbA1c level recorded in the medical chart.

RESULTS

HbA1c levels were significantly lower 1 year after implementing the DCCT protocol; 3 years later these same patients improved even further as evidenced by another decrease in HbAlC levels. The patients were taking more insulin (more Ultralente and regular insulin and less NPH) and had an increased number of injections at both the 1-year and 3-year follow-up points.

CONCLUSIONS

The DCCT protocol can be implemented in a large population of pediatric patients with the help of a nurse who is dedicated and available to the patients for ongoing adjustments and provides creative ways to overcome the barriers to achieving normoglycemia.
Satisfaction With Automated Telephone Disease Management Calls and Its Relationship to Their Use
Authors: Plette John D.
Published: April 2008

PURPOSE

this paper reports the results of an assessment of automated telephone disease management (ATDM) among patients in 2 randomized trials evaluating ATDM as an adjunct to usual care.

METHODS

During the 12-month follow-up interview, 256 low-income adults with diabetes from the intervention groups of 2 randomized trials were asked to respond to questions about their satisfaction with the ATDM process. Variation in satisfaction was examined across groups, and satisfaction reports were correlated with the extent to which patients completed ATDM assessments and used them to report glycemic levels or access educational messages.

RESULTS

Overall, 85% of patients reported that they were satisfied with the ATDM calls, 82% reported that they would be more satisfied with their health care if such calls were available to patients, and 76% reported that they personally would choose to receive such calls in the future. Most patients reported few difficulties completing ATDM assessments and found the calls to be a useful adjunct to their care. Some, however, found the calls intrusive; 16% reported that the calls were a bother.

CONCLUSIONS

Patients were satisfied with ATDM calls as part of their diabetes care. Satisfaction played some part in determining patients' use of ATDM assessment and health education, although other barriers also contributed to less than optimal usage rates.
Development of a Theory-Based Daily Activity Intervention for Individuals With Type 2 Diabetes
Authors: Tudor-Locke Catrine E. , Myers Anita M. , Rodger N. Wilson
Published: April 2008

PURPOSE

This article describes a theory-driven approach to developing a physical activity intervention for sedentary individuals with type 2 diabetes.

METHODS

Development of the intervention was based on 6 essential elements of program theory: problem definition, critical inputs, mediating processes, expected outcomes, extraneous factors, and implementation issues. Each element was formulated based on available literature and in collaboration with both intended service deliverers (diabetes educators) and recipients (sedentary persons with type 2 diabetes).

RESULTS

Diabetes education requires a simple physical activity intervention template that is feasible, acceptable, and effective in a variety of settings. Successful programs are individualized, specific, flexible, and based on walking. Pedometers have potential as self-monitoring and feedback tools. The primary expected outcome is an increase in physical activity, specifically walking. Behavior modification and social support are critical to adoption and adherence.

CONCLUSIONS

Theory-driven interventions specify what works for whom and under what conditions of delivery. The underlying theoryguides the evaluation, refinement, and clinical replication of an intervention. Recruitment, delivery, and follow-up are realworld implementation issues.
A Community Diabetes Educator Course for the Unemployed in South Auckland, New Zealand
Authors: Tregonning Pamela B. , Simmons David , Fleming Carole
Published: April 2008

PURPOSE

This paper describes an education program that targeted long-term unemployed people from the community and trained them to work as diabetes educators in their own communities in an attempt to address issues of cultural appropriateness.

METHODS

Government funding was obtained to conduct two 22-week training courses for people who had been selected by their communities. These courses built on participants' existing cultural skills and provided appropriate diabetes training.

RESULTS

The results indicate that the courses were successful both in creating a cadre of culturally acceptable diabetes educators and providing employment for course participants.

CONCLUSIONS

Previously unemployed lay people are able to provide diabetes education in the primary prevention and group settings. Such individuals are able to incorporate extensive cultural skills in their work.
Dissemination of Diabetes Care Guidelines: Lessons Learned From Community Health Centers
Authors: Walker Elizabeth A. , Engel Samuel S. , Zybert Patricia A.
Published: April 2008

PURPOSE

This study was conducted to evaluate the impact of a provider problem-based learning (PBL) intervention on screening for complications of diabetes in community health centers.

METHODS

A successive sampling design was used to compare selected standards of diabetes care delivered preintervention with the care delivered postintervention at 2 community health centers and 1 comparison centers. Two randomly assigned intervention sites received a PBL intervention focused on care guidelines for prevention of diabetes complications, with telephone follow-up over 12 months. Effects of the intervention were determined from an audit of 200 charts from each site.

RESULTS

The odds of having a glycosylated hemoglobin test more than doubled from preintervention to postintervention, and the odds of having a foot examination more than tripled across centers. Measurement of creatinine and glycosylated hemoglobin were associated; the odds of having one test tripled when the other had been measured. Rates for documentation of patient education were significantly lower at the intervention site where free patient education booklets were distributed.

CONCLUSIONS

Improvements in diabetes care were not consistent among community health centers. Interventions involving system and policy changes may be more effective in implementing and sustaining improvements than just provider education.
Physician Assistant Students and Diabetes: Evaluation of Attitudes and Beliefs
Authors: Fisk Diane M. , Hayes Risa P. , Barnes Catherine S. , Cook Curtiss B.
Published: April 2008

PURPOSE

Physician assistants are assuming a greater role in patient care in the US health system. The objective of this study was to examine attitudes and beliefs about diabetes among physician assistant trainees.

METHODS

A survey of 3 currently enrolled classes of physician assistant students was conducted using the Diabetes Attitude Survey (DAS, version 3). An additional question was presented to gather information about the level of hyperglycemia at which students would intensify diabetes therapy.

RESULTS

On average, students scored high on all subscales, indicating general agreement with the attitudes examined by the DAS. For 3 subscales (seriousness of type 2 diabetes, value of tight glucose control, and patient autonomy), significant differences were seen across year of training. When asked about the level of glucose control at which they would advance therapy, a wide range of responses occurred, with some being out of target.

CONCLUSIONS

Physician assistant students had favorable attitudes regarding type 2 diabetes. However, deficits appear to exist in understanding when to advance therapy. More studies on physician assistant students' knowledge of diabetes standards of care are required.
Health-Compromising Behavior and Diabetes Mismanagement Among Adolescents and Young Adults With Diabetes
Authors: Hanna Kathleen M. , Guthrle Diana W.
Published: April 2008

PURPOSE

this study examined the relationship between health compromising behavior, age, gender, and diabetes mismanagement.

METHODS

A total of 107 adolescents and young adults, 12 to 24 years old, with type 1 diabetes were asked to complete a health-compromising behavior scale and a diabetes mismanagement scale.

RESULTS

Based upon participants' responses, the study population was divided into 2 different groups: those involved in health compromising behavior and those not involved in such behavior. A multiple regression analysis was performed using age, gender, and health-compromising behavior as predictor variables and diabetes mismanagement as the outcome variable. Variables that accounted for significant variance in diabetes mismanagement were being female and being involved in health-compromising behavior.

CONCLUSIONS

Adolescents and young adults with diabetes appear to be either involved or not involved in health-compromising behavior. Being female and being involved in health-compromising behavior were associated with diabetes mismanagement.
Training Lay Health Educators to Conduct a Church-Based Weight-Loss Program for African American Women
Authors: Quinn Michael T. , McNabb Wylie L.
Published: April 2008

PURPOSE

Community-based lay health educators have been utilized in a range of settings and with a variety of health issues. However, little has been published about the specifics of training lay health educators to effectively deliver community-based programs. This paper describes the training used to prepare volunteer, church-based lay health educators to conduct a community-based weight-loss program, and the evaluation of that training.

METHODS

After recruitment through their respective churches, volunteer lay health educators were given structured training in how to conduct the PATHWAYS weight-loss program. Program sessions were observed to monitor program delivery, and participation rates and weight loss were evaluated.

RESULTS

The lay health educators were highly consistent in their delivery of the program content. Participant attendance was high and virtually all of the participants completed the program. Participant weight loss averaged 8.3 pounds, which correlated with session attendance.

CONCLUSIONS

Given training appropriate to the structure of the program and specific to the targeted health behavior, lay health educators can reliably and effectively administer even rather complex programs.
Current Computer Use by Diabetes Educators
Authors: Lewls Deborah
Published: April 2008

PURPOSE

the purpose of this study was to ascertain diabetes educators' current use of computer technologies.

METHODS

The study population -consisted of 279 randomly selected certified diabetes educators, all of whom were members of the American Association of Diabetes Educators. Participants were asked to complete the Attitudes Toward Patient Education Technology instrument.

RESULTS

Descriptive findings showed that most educators (89.6%) have access to computers and use them primarily for word processing (43%). Nearly 30% of participants had never accessed the Internet, and no significant difference was noted when this variable was categorized by age. In addition, age and gender were not significant predictors of computer use, although age was significantly related to computer ownership. Patient access and organizational issues were the primary barriers to computer use in patient education.

CONCLUSIONS

These findings provide further understanding of diabetes educators' computer use and integration of computer technology in the patient education process.
Sequencing Diet and Exercise Programs for African American Women With Diabetes
Authors: Nothwehr Faryle K. , Guare John , Marrero David G. , Hoon Helena
Published: April 2008

PURPOSE

This study was designed to compare the effects of 2 programs that present diet and exercise components in a different sequence.

METHODS

At an urban YMCA, African American women with type 2 diabetes, aged 30 to 65, were randomly assigned to either 10 weekly sessions about healthy eating followed by 6 weekly sessions about exercise or to the reverse sequence. Sessions consisted of small group discussions and physical activity or food tasting. Primary outcomes were attendance, percent of calories consumed from fat, fruit and vegetable intake, and minutes of exercise per week. Measures were taken at baseline, and 4 and 12 months after the program.

RESULTS

The only group difference found at the 12-month follow-up was in diastolic blood pressure. Time effects for both groups combined included an increase in minutes of activity, an increase in vegetable intake, and a decrease in percent of calories consumed from fat.

CONCLUSIONS

This study does not provide definitive evidence of which sequence may be best to bring about behavior change. The effects of sequencing difficult behavioral changes such as diet modification and establishing an exercise habit deserve further study.
The Role of the Certified Diabetes Educator in Telephone Counseling
Authors: Hayes Joy T. , Boucher Jackie L. , Pronk Nicolaas P. , Qehling Eve , Spencer Mary , Waslaski Janelle
Published: April 2008

PURPOSE

this paper describes a telephone-based, outcomesfocused approach to diabetes education provided by certified diabetes educators (CDEs).

METHODS

Random chart audits were conducted to evaluate the scope of practice and effectiveness of telephone-based interventions provided by CDEs to people with diabetes. Four case studies and a sample prevention case are used to illustrate the role of telephone-based CDEs in providing diabetes education.

RESULTS

Counseling provided by CDEs helped to identify potential barriers and strategies for making lifestyle behavioral changes.

CONCLUSIONS

Telephone-based counseling is a brief, effective, ongoing intervention that gives patients with diabetes immediate access to CDEs who provide education to support lifestyle behavioral changes.
Patient Priorities and Needs for Diabetes Care Among Urban African American Adults
Authors: Batts Marian L. , Gary Tiffany L. , Huss Karen , Hill Martha N. , Bone Lee , Brancati Frederick L.
Published: April 2008

PURPOSE

this study was conducted to determine diabetes care priorities and needs in a group of urban African American adults with type 2 diabetes mellitus.

METHODS

One hundred nineteen African American adults with type 2 diabetes, aged 35 to 75, received behavioral/educational interventions from a nurse case manager, a community health worker, or both. Priorities and needs were assessed during 3 intervention visits.

RESULTS

The most frequently reported priorities for diabetes care were glucose self-monitoring (61%), medication adherence (47%), and healthy eating (36%). The most frequently addressed diabetes needs were glucose self-monitoring and medication adherence. Most of the intervention visits (77%) addressed nondiabetes-related health issues such as cardiovascular disease (36%) and social issues such as family responsibilities (30%).

CONCLUSIONS

Participants' self-reported priorities for diabetes care directly reflected the diabetes needs addressed. Needs beyond the focus of traditional diabetes care (social issues and insurance) are important to address in urban African Americans with type 2 diabetes. Interventions designed to address comprehensive health and social needs should be included in treatment and educational plans for this population.
Accuracy of Self-Monitoring of Blood Glucose: Impact on Diabetes Management Decisions During Pregnancy
Authors: Henry M. Joann , Major Carol A. , Reinsch Sibylle
Published: April 2008

PURPOSE

This study tested the hypothesis that the accuracy of self-monitoring of blood glucose (SMBG) values of patients with diabetes during pregnancy deviates substantially from reference values.

METHODS

The patients' glucose values were measured on 6 different SMBG meters; reference values were from the HemoCue B Glucose Analyzer. Over a 5-year period, 1973 comparisons between SMBG values and reference values were recorded during clinic visits and used for this study. Data were analyzed for percent of values that varied more than ±10.5% and ±15.5% from the reference value. Out-of-range data at each variance level were analyzed to determine the impact on medical management if decisions were based solely on SMBG values.

RESULTS

One third of SMBG readings deviated significantly, which could adversely affect treatment for half of these patients if diabetes management was based on SMBG values. At the 10.5% deviation level, 34% of SMBG meter readings were out of range; 54% of these would have implied erroneous treatment. At the 15.5% deviation level, 18% were out of range; 63% of these would have implied erroneous management.

CONCLUSIONS

The accuracy of home meters should be verified at regular intervals, and SMBG values should not be the sole criterion for diabetes management during pregnancy.
Tablet-Breaking Ability of Older Persons With Type 2 Diabetes Mellitus
Authors: Wilson Margaret-Mary G. , Kaiser Fran E. , Morley John E.
Published: April 2008

PURPOSE

the purpose of this study was to assess the ability of older persons with type 2 diabetes to accurately break in half 2 different formulations of micronized glyburide tablets.

METHODS

Thirty persons with type 2 diabetes, over age 70, were recruited from the St Louis University geriatric clinics. Participants were randomly assigned to 2 groups. Group A broke 30 Glynase Prestabs and 30 generic tablets using 2 different manual tablet-breaking methods. Group B broke 15 Glynase Prestabs and 15 generic tablets without instructions. Visual analog scales were used to assess pain and difficulty of tablet breaking.

RESULTS

A higher percentage of successful tablet breaking was reported with Glynase Prestabs (80%) compared with the generic tablets (33%). Mean pain scores for breaking Glynase Prestabs were 0.1 (Group A) and 0.9 (Group B). Higher pain scores were obtained for the generic tablets (2.1 for Group A, 3.2 for Group B). Glynase Prestabs were easier to break in both groups, and the resultant half tablets showed less variance from the expected theoretical weight (50% of whole parent tablet weight).

CONCLUSIONS

Older adults broke Glynase Prestabs more accurately and with less difficulty than generic micronized glyburide tablets. This variation in ease of tablet breaking and accuracy between different tablet formulations affect bioavailability and patient compliance.
Patient Perceptions of Prandial Oral Therapy for Type 2 Diabetes
Authors: Bonneville Miohele , Colgin Joan , Nalesnick Jo Ann , Perez Joan , Wentz Lynne
Published: April 2008

PURPOSE

This survey was conducted to assess patient perceptions of glycemic control, convenience, and flexibility of a prescribed prandial oral therapy for type 2 diabetes mellitus.

METHODS

Questionnaires distributed by physicians yielded baseline responses from 3696 patients who were beginning repaglinide treatment. Data were analyzed from 1233 respondents who also completed follow-up questionnaires after 4 weeks of treatment.

RESULTS

Among respondents, 60% were taking repaglinide with other antidiabetic agents in combination therapy; 59% were taking metformin, and 24% were taking troglitazone. Most respondents (84%) indicated that they were "satisfied" or "very satisfied" with repaglinide therapy, 92% wished to continue its use, and 60% believed that the treatment had improved their attitude toward taking antidiabetic medication. Patients perceived that fasting blood glucose levels were reduced during treatment, as was the incidence of hyperglycemia. Corresponding changes in perceived frequency of hypoglycemia during repaglinide treatment were minimal.

CONCLUSIONS

Patient perceptions of prandial oral therapy with repaglinide were predominantly positive, due mostly to the perception that glucose control was achieved, with minimal perception of any increase in hypoglycemic episodes.
Perceived Difficulty of Diabetes Treatment in Primary Care: Does it Differ by Patient Ethnicity?
Authors: Egede Leonard E. , Miohel Yvonne
Published: April 2008

PURPOSE

The purpose of this cross-sectional study was to determine the attitudes of internal medicine physicians toward treating diabetes in different patient ethnic groups and compared with treating common chronic medical conditions in primary care.

METHODS

The survey instrument was administered to 55 internal medicine physicians. An e-mail message was sent to each physician with a hyperlink to a site where the survey could be completed. The instrument was a modified, quantitative 10-point scale designed to measure attitudes regarding the difficulty of treating diabetes.

RESULTS

Diabetes was perceived to be more difficult to treat than hyperlipidemia and angina. African Americans with diabetes were perceived to be more difficult to treat than Caucasian patients. Difficulty in treating diabetes was comparable to that for hypertension, arthritis, and congestive heart failure. Physicians were confident about treatment efficacy for diabetes and changing diabetes outcomes, but not about the adequacy of time and resources for diabetes treatment.

CONCLUSIONS

Diabetes was perceived as a difficult disease to treat, African American patients were more difficult to treat, and time and resources were inadequate for diabetes treatment. To improve diabetes care, there is a need to address these attitudes and concerns of internal medicine physicians.
A National Job Analysis of Certified Diabetes Educators by the National Certification Board for Diabetes Educators
Authors: Zrebiec John
Published: April 2008

PURPOSE

The job analysis described in this report was conducted by the National Certification Board for Diabetes Educators (NCBDE) to (1) provide a basis for documenting the continuing validity of the certified diabetes educator examination (CDE), (2) define areas that should be assessed in future certification examinations, and (3) ensure that the content of certification examinations is job related.

METHODS

A diabetes educator job task list was developed and used to create a job analysis survey. The survey was distributed randomly to 1079 CDEs throughout the United States.

RESULTS

Of the 1079 surveys that were distributed, 327 were suitable for analysis, with relevant demographic subgroups adequately represented. An examination matrix and detailed content outline were constructed from the survey data that will be used by the NCBDE to assemble future test forms.

CONCLUSIONS

Specifications for the CDE examination were developed that were directly related to the important activities that diabetes educators perform. Future forms of the CDE examination will be matched to job-related, criterion-referenced test specifications and will have strong evidence of content validity. Future forms of the exam will contain 200 items at specified cognitive levels with a representative sampling of tasks within 4 core areas from the detailed content outline.