bluuebunny/crossref_metadata_2025 huggingface dataset:
National Standards for Diabetes Patient Education Programs: Pilot Study Results and Implementation Plan
Authors: Berlin Nina , Sims Dorothea , Belloni James , Brimberry Jerry , Etzwiler Donnell , Hiss Roland , Kraimer Nancy , Krueger Keatha , Leichter Steven , Lipsett Lois , Paduano Darlene
Published: April 2008

National Standards for Diabetes Patient Education Programs and a plan to implement them have been developed and pilot tested by the diabetes community in a four-year process conducted under the auspices of the Na tional Diabetes Advisory Board. The pilot study demonstrated the feasibil ity of implementing a na tional quality assurance process for diabetes pa tient education programs. Evidence from the pilot study also suggested that a national quality assur ance plan will foster third-party reimbursement for ambulatory diabetes patient education. The National Coalition for Recognition has been established to conduct for mal review and recogni tion of programs seeking to meet the National Standards.
Diabetes and Sexual Health
Authors: Manley Ginger
Published: April 2008

Physical sexual health concerns associated with diabetes include impotence and retrograde ejaculation in males, and failure to lubricate and increased threshhold for orgasm in females. Desire problems for both males and females are rarely a result of diabetes. Psychosocial adaptation to changes in physical sexual function includes changes in self- esteem and alterations in relationships and noles. For some persons, the sexual alterations associated with diabetes represent a greater adjustment than any other aspect of the diabetes. An overview of the physical as well as the psychosocial sexual alterations in diabetes are presented as a basis for educating, coun seling, and referring patients who are experiencing sex ual health concerns.
How Clinician Communication Patterns Affect Patients' Comprehension and Satisfaction
Authors: Mazzuca Steven A. , Weinberger Morris
Published: April 2008

The literature is inconsistent in its portrayal of clinical communication associated with knowledge, compli ance, and satisfaction of patients. This study inves tigates whether different outcomes are associated with characteristic patterns of communication. En counters between 32 dia betes patients and a variety of diabetes professionals were videotaped. Statements by clinicians were analyzed and related to patients' comprehension of their regimens and satisfaction with care. Differences be tween the comprehension- and satisfaction-associated patterns call into question the assumptions that (1) there is a single best model for doctor-patient relationships in chronic diseases, and (2) active participation of patients is always a desirable goal.
Diabetes Education—A Universal Need
Authors: Rodriguez Sebastian
Published: April 2008

About 20 years ago, when diabetes education and the development of the health care team were not quite bom, Dr Rodri guez had the dream and the enthusiasm to help the physicians and health team members of Latin America. With unswerv ing determination, end less patience, and good humor, he welded to gether the courses des cribed in this essay. He probably knows more physicians in South and Central America than any one else. His contribution is most timely. —EDS.
Increasing the Utilization of Outpatient Diabetes Education Programs
Authors: Chapko Michael K. , Norman Jan , Bell-Hart Martha , Nagusky Deborah , Connell Frederick A.
Published: April 2008

Under the auspices of the Washington State Diabetes Con trol Program, 22 local diabetes outpatient education programs participated in a project to iden tify strategies for improving the use of their programs. A phone survey of 228 physicians and 64 patients with diabetes in Washington State was conducted to determine awareness of the programs, frequency, and type of patient referrals, and percep tions of strengths and weak nesses of the programs. Ninety- one percent of physicians and 66% of patients reported they knew of local programs, but only 36% of the physicians routinely referred patients. The primary source of information about diabetes and about diabetes education programs reported by patients was their physician. Specific survey find ings were used by participants to develop strategies for increasing referrals.
Diabetological Education in Latin America
Authors: Serantes Nestor A.
Published: April 2008

Current diabetological education in Latin America reflects the characteristics of underdeveloped countries: low prevalence of IDDM; earlier onset age and presence of NIDDM in nonobese subjects; a special type of diabetes related to malnutrition; malnutrition itself; and, most of all, deficient medical care. Three other factors are also at work in Latin America: linguistic uniformity, which facilitates education; intensification of ur ban underdevelopment; and the short supply of diabetologists and other health team members. The latter two are definite hand icaps. Only four Latin American schools train diabetes specialists. Latin American diabetes patient education is carried out through - 130 courses and nine diabetes camps. Eight journals and a multitude of booklets distributed by 27 lay-diabetes societies pro vide additional information for literate diabetic patients. Much more is needed.
Nurses' Expectations and the Realities of Multidisciplinary Education
Authors: Hopper Susan V. , Lange Marcia H.
Published: April 2008

Although increasing emphasis has been placed on multidisci plinary teams, there is a signifi cant discrepancy between dia betes nurse educators' per ceptions of actual and ideal multidisciplinary participation in diabetes patient education (DPE). Twenty-six diabetes nurse educators rated frequencies of ideal and actual participation from 1 (never) to 5 (always). The mean ideal ratings for physicians, pharmacists, social workers, dietitians, and nurses were greater than 4.0, but only nurses and dietitians received comparable actual participation ratings.
Questions That Diabetes Patients Ask
Authors: Stone Morton B.
Published: April 2008

The questions that readers of Diabetes in the News pose to the editors provide interesting signposts to what subjects need to be reinforced by educators. General diabetes questions are the most popular, followed by queries on diet, insulin, and complications.
Toward Normoglycemia: Studies in Computer-assisted Insulin Delivery
Authors: Jovanovic Lois , Peterson Charles M.
Published: April 2008

Hand-held computer-assisted insulin delivery was studied in patients with Type I diabetes mellitus. Initially studies were undertaken with continuous subcutaneous insulin (CSII) delivery systems. A second computer program was then developed that utilized inter mediate (NPH) and short-acting (Regular) insulins. Computer usage was found to be accep table to patients and safe in comparison with intensive insulin delivery methods. During periods of computer use, patients were found to perform more blood glucose determinations and achieve lower mean blood glucose values as evidenced by home monitored blood glucose values as well as hemoglobin AIc values. Computer-assisted insulin delivery may be a useful adjunct to diabetes education in the near future.
Patient Knowledge Compared With National Guidelines for Diabetes Care
Authors: Teza Susan L. , Davis Wayne K. , Hiss Roland G.
Published: April 2008

Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes Education Profile (DEP). Patient performance on these instruments was compared with corresponding items in the Ambulatory Care Facilities section of the Guide lines for Diabetes Care published by the American Diabetes Associ ation and the American Associ ation of Diabetes Educators. In general, insulin-dependent persons scored higher than noninsulin-dependent persons. Those taking insulin (whether insulin-dependent or not) scored higher than noninsulin-dependent persons whose regimen did not include insulin. The findings emphasize the need to subdivide any analysis of clinical diabetes or diabetes education into groups based on insulin use or nonuse.
Capillary Blood Glucose Monitoring: A Comparison of Two Hospital Quality Control Programs
Authors: Sideman Kate , Padilla Betty , Huff Thomas A. , Stachura Max E.
Published: April 2008

Clinical utility of capillary blood glucose (CBG) values rests on timeliness and accuracy. Reflec tance meters permit bedside glucose monitoring with accuracy and precision. Given an appro priate monitoring system, relia bility of CBG values depends on the personnel performing the test. We compared two hospital CBG programs: Hospital I, where monitoring occurred on four general nursing units; and Hospital II, where monitoring occurred on a diabetes-focused unit. CBG readings were com pared with clinical laboratory glucose values. At Hospital I the absolute error was 7. 23 % ± 1. 08 %; the directional error was 0.63% ±1.38 %. At Hospital II the absolute error was 9.31 % ± 0.38%; the directional error was -5.28 % ± 0.52 %. The larger directional error at Hospital II was monitor generated. We conclude that (1) one monitor brand should be used hospitalwide; (2) quality control systems can accommodate practical hospital settings; and (3) general nurse CBG reliability can be equivalent to that of specialized nurses.
Risk Taking Among Diabetic Clients
Authors: Joseph Dayle Hunt , Schwartz-Barcott Donna , Patterson Barbara
Published: April 2008

Diabetic clients must make daily decisions about their health care needs. Observational and anecdotal evidence suggests that vast differences exist between the kinds of choices diabetic clients make and the kinds of chances they are willing to take. The purpose of this investigation was to develop a diabetic risk-assessment tool. This instrument, which is based on subjective expected utility theory, measures risk-prone and risk-averse behavior. Initial findings from a pilot study of 18 women clients who are on insulin indicate that patterns of risk behavior exist in the areas of exercise, skin care, and diet.
Alternatives to the Exchange System for Teaching Meal Planning to Persons With Diabetes
Authors: Pastors Joyce Green
Published: April 2008

Although the most well known, exchange lists are not the only meal-planning approach for persons with diabetes. This paper outlines the steps in the nutrition education process, including initial and continued education stages, and presents six alternative approaches for individualizing meal planning. These include the High Carbohydrate-High Fiber Exchange System, Calorie/Fat Counting, Total Available Glucose, the Point System, Month of Meals, and Individualized Sample Menus. The approaches are rated according to emphasis on weight loss, glucose control, and ease of learning and according to type of diabetes. A complete resource guide is provided.
The Scope of Practice of Diabetes Educators in a Metropolitan Area
Authors: Cypress Mariorie , Wylie-Rosett Judith , Engel Samuel S. , Stager Terry B.
Published: April 2008

A survey of 108 members of a local metropolitan AADE chapter was conducted to assess (1) current roles and responsibilities of diabetes educators with respect to medical management and patient education, and (2) the use of behavioral strategy techniques among diabetes educators. Nurses and dietitians specializing in diabetes care performed a range of responsibilities. Approximately 75% of the nurses performed standard patient education roles and 20% performed the majority of roles traditionally considered to be in the medical domain, including insulin adjustment. More than half of the respondents had not received formal training in the use of behavioral strategies. Formal training was positively associated with greater use of behavioral techniques. Training for diabetes educators should include behavioral intervention strategies. Nurses specializing in diabetes care may also need training regarding physical assessment for chronic complications, and knowledge regarding adjustment of insulin and oral hypoglycemic medications.
Perceived and Actual Knowledge of Diet by Individuals with Non-Insulin-Dependent Diabetes
Authors: Watson Judith F. , DuFourd Sally
Published: April 2008

A study was conducted to investigate both the perceived and actual knowledge of diet by 101 individuals with non-insulin- dependent diabetes mellitus (NIDDM). A survey instrument was developed containing three sections: perceptions of diet knowledge, demonstrated knowledge of diet, and demographic information. Perceived and actual knowledge of diet in the study group were compared with the following variables: years of education, types of diabetes regimen, particpation in care, recency of dietary instruction, understanding of diet, and levels of self blood glucose monitoring (SBGM). Analysis indicated significant differences for knowledge and levels of education, perceptions and knowledge and recency of instruction, perceptions and knowledge and understanding of diet, and perceptions and self blood glucose monitoring. A positive linear relationship was noted between perceptions and actual knowledge of the diabetic diet.
Management of Obesity in Diabetes Mellitus
Authors: Hamilton Carlene C. , Geil Patti B. , Anderson James W. , Anderson James W.
Published: April 2008

A primary goal of treatment in obese individuals with NIDDM is weight loss and maintenance. Obesity is a precipitating factor for the development of NIDDM in individuals who are genetically at risk. A variety of weight-loss regimens are available to match the specific needs and lifestyles of individuals. Hypocaloric high-fiber diets have been found to be effective in achieving weight loss, as well as aiding in glycemic and lipid control. very low calorie diets, administered under medical supervision, are useful for obese NIDDM patients with 18-55 kilograms of weight to lose. Lifestyle education appears to be an important element of any successful weight loss program.
A Regional Diabetes Nutrition Education Program: Its Effect on Knowledge and Eating Behavior
Authors: Pedersen Annette L. , Lowry Karen R.
Published: April 2008

The effect of a nutrition education program on knowledge and self-care behavior in a group of individuals with diabetes was evaluated. The nutrition education program was developed using outlines and knowledge tests produced by the Universiy of Michigan Diabetes Research and Training Center. The program, sponsored by the American Diabetes Association, Akron Chapter, was presented free of charge to Northeast Ohio area residents. Forty-four individuals participated in the study. Results indicated a statistically significant (p<0.01) gain in knowledge but no statistically significant change in eating behavior for the sample. However, post-food records indicated that the mean for the percentage of total kcalories (kcals) from protein and fat (ie, 20% and 28%, respectively) were within the American Diabetes Association's recommendations of no more than 20% of kcals from protein and 30% of kcals from fat. In addition, the percentage of kcals from carbohydrate and the recommended total number of kcals improved toward the recommended levels.
Measuring the Attitudes and Beliefs of American Indian Patients With Diabetes
Authors: Womack Ranae Bohan
Published: April 2008

Diabetes is recognized as a major health problem for American Indians. This study examined the attitudes and beliefs of American Indian patients with diabetes using the revised Diabetes Attitude Scale (DAS). Revised DAS factors represent patients'attitudes toward the need for special training to provide diabetes care, patient compliance, the seriousness of non-insulin-dependent diabetes mellitus (NIDDM), the relationship between blood glucose levels and complications, the impact of diabetes on the patient's life, patient autonomy, and team care. Data were collected from subjects at Indian Health Service hospitals on two American Indian reservations in northern Minnesota. Results of the analysis indicated significant differences in attitudes related to seriousness of the disease and autonomy in care decisions, after controlling for sex and educational level of the respondents.
The Relationship Between Diabetes-Related Attitudes and Patients' Self- Reported Adherence
Authors: Anderson Robert M. , Fitzgerald James T. , Oh Marys.
Published: April 2008

This study involved 1202 patients who were placed into low adherence or high adherence groups based on their answers to questionnaires. The attitudes of each group were compared for a variety of adherence behaviors. Patients who reported high levels of adherence tended to have attitudes more in accord with diabetes experts. Members of the high adherence group strongly supported the need for special training for health care professionals who treat diabetes, favored team care, accepted the importance of patient compliance, acknowledged the seriousness of non-insulin-dependent diabetes mellitus (NIDDM), and recognized the relationship between glucose control and complications. Differences in attitudes between high- and low adherence groups were more prevalent for difficult adherence areas, eg, diet and exercise, than for easy adherence areas, eg, carrying sweets or diabetic identification. An understanding of patients' attitudes can help diabetes educators and patients develop realistic and relevant self-care plans.
The Knowledge and Practices of Registered Nurse, Certified Diabetes Educators: Teaching Elderly Clients About Exercise
Authors: Ruby Karen L. , Blainey Carol A. , Haas Linda B. , Patrick Maxine
Published: April 2008

This study identified the knowledge base and practices of Registered Nurse,. Certified Diabetes Educators (RN, CDEs) regarding their exercise teaching programs for elderly clients who have non-insulin-dependent diabetes mellitus (NIDDM). The random sample of 197 AADE members surveyed by questionnaire was a highly educated and experienced group. RN, CDEs who worked 30 or more hours per week in diabetes education or attended four or more continuing education (CE) programs per year had significantly more comprehensive exercise teaching program designs and instructional techniques to enhance elderly NIDDM clients' learning (P<.05). However; many CDEs do not teach their elderly clients about exercise due to lack of resources, lack of specific knowledge to prescribe exercise, and negative stereotypes of elderly clients' ability to exercise. Greater availability of educational programs for CDEs to explore curriculum development, program planning, evaluation, and exercise prescription for elderly clients with multisystem disease is recommended.
Tool Chest
Authors: Ahroni Jessie H.
Published: April 2008

The purpose of this department is to pro vide a formal for sharing innovative educa tiotial strategies or tools for use in patient or professional diabetes education. Authors are invited to submit manuscripts that describe a strategy or tool and its im plications for practice. Manuscripts should be limited to three to five double-spaced pages and sent to Tool Chest edito r Kathryn Godley, MS, RN, CDE, 23 Harri son Avenue, Delmar; NY 12054.
Increasing Children's Responsibility for Diabetes Self-Care: The In Control Study
Authors: McNabb Wylie L. , Quinn Michael T. , Murphy Donna M. , Thorp Frank K. , Cook Sandy
Published: April 2008

The purpose of this pilot study was to test the hypothesis that children can learn to become more independent in their own diabetes self management without compromising their metabolic control. Twenty four children (ages 8 to 12 years) with insulin- dependent diabetes mellitus (IDDM) were matched by age and race, then randomly assigned either to a 6-week, self management education program (experimental) or to receive usual care (control). A questionnaire was administered to the parents to determine the frequency with which 35 diabetes management behaviors were performed and the degree to which children assumed responsibility for these behaviors. Glycohemoglobin levels were monitored at baseline and at posttreatment, 12 weeks after baseline. At the posttreatment, children in the experimental group were found to be assuming significantly more responsibility for their diabetes self-care than were children in the control group. No decrease in the frequency with which self-care behaviors were performed was observed, and metabolic control was maintained. The results suggest that a diabetes self-management education program for children ages 8 to 12 years can be effective in facilitating children becoming more responsible for their own diabetes management.
Facilitating Diabetes Self-Management
Authors: Wierenga Mary E. , Beauchamp Hewitt Jeanne
Published: April 2008

The purpose of this study was to enhance sensitivity to and understanding of the perceptions of persons with diabetes by analyzing these individuals' unsolicited comments on structured questionnaires. Twenty of 66 adults with tion-insuliti-depeizdetit diabetes mellitus (NIDDM) who participated in a study to modify their eating habits wrote a total of 122 unsolicited comments on three different questionnaires. A systematic analysis of the content of these comments resulted in seven coding categories: personal philosophy; knowledge deficit; weight or blood sugar problems; diet, exercise, or medication problems; self-care activity; stress; and success. Further analysis resulted in a trilevel schema (survival, regulation, success) depicting how individuals learn to manage their diabetes. The problem-identification and seeking-help behaviors identified in the survival level gradually changed to learning to live with the regimen in the regulation level. Respondents whose activities were in the success level demonstrated more autonomy than persons in the other two levels. A health orientation rather than a problem orientation also was seen in the success level. Consequently, teaching strategies should be tailored to the client's level of self-care, with an emphasis on assisting them toward the success level.
Patient Perceptions of Benefits and Concerns Following Pancreas Transplantation
Authors: Zehrer Cindy L. , Gross Cynthia R.
Published: April 2008

The purpose of this study was to assess patient perceptions of the impact of pancreas transplantation on various aspects of life, as well as perceptions of the benefits of and concerns with the procedure. All surviving adult patients who had received a pancreas transplant at a midwestern hospital and were at least 1 year posttransplant at the time of the study (N=138) were sent a self-report questionnaire that included demographic data, questions about life satisfaction, quality of life, symptoms, and health impact. Patients with pancreas graft function reported less pain with healthcare treatment, fewer episodes of feeling physically ill, fewer dietary restrictions, less interference with family life, fewer health limitations in interpersonal relationships and leisure activities, and feeling good about themselves compared with those without graft function. A majority of patients with functioning grafts cited the following benefits: freedom from insulin reactions, normal blood sugars, freedom from insulin injections, freedom from a specialized diet, decreased chance of amputation, feeling better physically, more feelings of hope for the future, and more freedom and control over life. Major concerns posttransplant included side effects and the expense of immunosuppressive medications.
Utilizing a 24-Hour Dietary Recall and Culturally Specific Diabetes Education in Mexican Americans With Diabetes
Authors: Elshaw Evelyn B. , Young Eleanor A. , Saunders Michelej. , Mcgurn Wealtha C. , Lopez Linda C.
Published: April 2008

Two objectives were established for this study: 1) to assess the impact of a culturally specific, intensive diabetes education program on dietary patterns, and 2) to assess nutrient consumption relative to the Recommended Dietary Allowances. The study population consisted of elderly Mexican Americans with diabetes living in Harlingen and Brownsville, Texas. The experimental group (n=78) participated in an intense, 2-hour nutrition education session, while the control group (n=74) did not. The education session was conducted for groups of eight subjects via videotapes and interactive discussion. All groups experienced significant weight loss except the women in the experimental group. After the education program, however, the experimental women had increased the percentage of calories consumed daily from carbohydrate. Mean calcium consumption was substantially less than the RDA in all groups, and inadequate amounts of ascorbic acid and vitamin A often were consumed. Intensive, frequent, long-term follow-up appears essential for more sustained results.
Use of Carbohydrate Counting for Meal Planning in Type I Diabetes
Authors: Gregory Rebecca Pratt , Davis Dianne L.
Published: April 2008

Certain questions often arise regarding carbohydrate counting, such as: Why use carbohydrate counting ? Where does one start? How much carbolrydrate is prescribed? How does one balance the diet? How is carbohydrate counting taught to patients? Which patients are the best candidates for carbohydrate counting? This article provides possible answers to these questions based on clinical experience at the Vanderbilt University Medical Center Diabetes Research and Training Center, and the Diabetes Control and Complications Trial.
An Outpatient Model of Integrated Diabetes Treatment and Education: Functional, Metabolic, and Knowledge Outcomes
Authors: Abourizk Nicolas N. , O'Connor Patrickj. , Crabtree Benjamin F. , Schnatz J. David
Published: April 2008

A cohort of 137 itisulin-ti-eated adults with diabetes was evaluated at enrollment in a diabetes education and care program; 69 completed follow-up evaluations (mean=11.2 months) to ascertain clinical outcomes. Factors that predicted change in metabolic, functional, and knowledge status were identified. The metabolic status of this cohort also was compared with a similar group of patients from a health maintenance organization (HMO) in a neighboring state. The mean HbA1c decreased from 9.97% at enrollment to 7.53% at follow-up. Functional status scores did not improve from baseline to follow-up. The relationship between knowledge and metabolic control differed for subjects with diabetes of long duration and short duration. A predictor of improved HbA1c was baseline HbA1c. A predictor of improved symptom score included white race or Hispanic origin. Patients who attended this program had better metabolic outcomes than the comparison group of patients.
Developing and Implementing a Pharmaceutical Care Model in an Ambulatory Care Setting for Patients With Diabetes
Authors: Van Veldhuizen-Scott Meri Kay , Widmer Laurel B. , Stacey Sallya. , Popovich Nicholas G.
Published: April 2008

This study evaluated pharmaceutical care as an adjunct to an existing, coordinated-care program at a Regional Diabetes Center. The progress of a control group receiving the standard pharmacist instruction was compared with two treatment groups receiving additional small group or individual supplementary education for a 2-month period. Outcome evaluation included assessment of individual diabetes management through blood glucose monitoring and responses on a pretest and posttest questionnaire. Patients in the treatment groups demonstrated significantly lower average weekly blood glucose levels and a decreased incidence of hyperglycemic episodes compared with the control group. Questionnaire data for both treatment groups demonstrated a significant increase in patient understanding of diabetes medications and medications for associated illnesses, an increase in knowledge about blood glucose monitoring, and a positive difference in perceptions/attitudes toward diabetes and communication with the pharmacist. This approach is consistent with the concept of pharmaceutical care in which the pharmacist helps patients avoid long-term complications and thus improve their quality of life.
A Community-Based, Culturally Sensitive Education and Group-Support Intervention for Mexican Americans With NIDDM: A Pilot Study of Efficacy
Authors: Brown Sharon A. , Hanis Craig L.
Published: April 2008

The purpose of this study was to determine the feasibility of providing a diabetes patient education and group-support intervention that was directed by a Mexican-American clinical nurse specialist (CNS), dietitian, and community worker; consistent with national standards; and designed for the Mexican-American culture. In a rural Texas-Mexico border community, subjects with diabetes were randomly selected to participate in the intervention, and a family member of each subject participated as a support person. The intervention involved 8 weeks of educational sessions with instruction on nutrition, blobd glucose self-monitoring, exercise, and other diabetes self-management topics, and provided group support. Group discussion was facilitated using a series of Spanish-language videotapes that had been developed and previously tested in the target Mexican-American community. Results suggested statistically significant improvements in diabetes knowledge, fasting blood sugar levels, and glycosylated hemoglobin levels. The study documented the feasibility and potential benefits of the intervention.
Color Vision Testing of Healthcare Personnel
Authors: Spencer Lois N.
Published: April 2008

The purpose of the study was to identify and describe color vision testing of healthcare personnel who do glucose monitoring within a hospital. The subjects were 359 members of a nursing staff. Data were collected from nurses participating in a certification program for blood glucose monitoring. The lshihara plates were used to screen for a color vision deficiency. The results offered no evidence that screening of staff provided any benefit for patient care.
Using Telecommunication Technology to Manage Children with Diabetes: The Computer-Linked Outpatient Clinic (CLOC) Study
Authors: Marrero David G. , Vandagriff Julie L. , Kronz Kathy , Fineberg Naomi S. , Golden Michael P. , Msn Deborah Gray , Orr Donald P. , Wright James C. , Johnson Nancy B.
Published: April 2008

The purpose of this study was to evaluate the effrcacy of using a telecommunication system to assist in the outpatient management of pediatric patients with insulin- dependent diabetes. Metabolic control, patients' psychosocial status, family functioning, perceived quality of life, patterns of parental/child responsibility for daily diabetes maintenance, and nursing time-on-task were evaluated. One hundred six pediatric patients (mean age= 13.3 years) were randomly assigned to an experimental or control outpatient clinic for 1 year. Experimental subjects transmitted self-monitoring blood glucose data by modem to the hospital every 2 weeks. Transmitted data were reviewed by nurse practitioners who telephoned subjects to discuss regimen adjustments. Control subjects received standard care with regimen adjustments made by physicians. There were no significant between-group differences for metabolic control, rates of hospitalization or emergency-room visits, psychological status, general family functioning, quality of life, or parent-child responsibility. A significant decrease was noted in nursing time-on-task for experimental subjects.
Locus of Control, Social Support, and Adherence to the Diabetes Regimen
Authors: Tillotson Lacey M. , Smith M. Shelton
Published: April 2008

There is a need to better understand how psychosocial factors influence regimen adherence behavior. Therefore, the purpose of this study was to assess the ability of internal diabetes locus of control and social support to predict adherence to a weight-control regimen among persons with non-insulin-dependent diabetes mellitus (NIDDM). A community-based sample of 465 patients with NIDDM was interviewed. Regression analyses revealed that internal locus of control and social support were modest but statistically significant predictors. Correlation analyses showed that internal locus of control was not related to weight control in the high social support group. In the low social support group, a stronger internal locus of control was not associated with weight management. The ways in which internal locus of control and social support work together were not clear. The findings suggest that these two factors are advantageous for promoting regimen adherence.
The Influence of Demographic and Treatment Variables on the Health Beliefs of Adults with Diabetes
Authors: Quackenbush Patricia A. , Brown Sharon A. , Duchin Sally P.
Published: April 2008

In this study a secondary analysis was performed of data collected previously by two of the authors (SAB, SPD) concerning the health beliefs of patients with diabetes. Demographic data included age, gender, race, and education level. Diabetes-related data included length of time since diagnosis, number of physician visits related to diabetes within the last year, and the type of treatment regimen. These factors were thought to influence the health beliefs of adults with diabetes and therefore affect patient compliance with recommended health behaviors.
Quality of Life for Parents of Children and Adolescents With Type 1 Diabetes
Authors: Spezia Faulkner Melissa , Clark Frances Sholar
Published: April 2008

The purpose of this study was to examine the issue of quality of life (QOL) of parents with children and adolescents with type I diabetes. Parental QOL was measured by the Parents Diabetes Quality of Life Questionnaire. Parental life satisfaction was most affected by the burden the child's diabetes placed on the family. The event having the most impact on parental QOL was the frequency of telling others about the child's diabetes. The greatest worry was that the child would develop complications from diabetes. Parents of school-aged children experienced significantly greater life satisfaction than parents of adolescents. Married parents had higher life satisfaction than those who were divorced. Metabolic control, reflected by HbA1c values, was associated with the life satisfaction of parents.
Clinical Challenges of Type B Insulin Resistance: A Case Study
Authors: Freeland Barbara S. , Paglia Roseanne E. , Seal Dawn L.
Published: April 2008

In this article, a case study is presented of a 44-year-old woman with a rare disorder of type B insulin resistance. This autoimmune syndrome is caused by circulating antibodies directed at the insulin receptor. These antibodies impair insulin interaction with the cells, resulting in insulin resistance that can be so severe as to require thousands of units of exogenous insulin per day The unusual presentation and management of this patient presented a challenge to nursing and other healthcare disciplines. This report includes a description of the diagnosis, treatment, discharge planning, and follow-up care.
The Significance of Identity in the Adjustment to Diabetes Among Insulin Users
Authors: Goldman Joanne B. , Maclean Heather M
Published: April 2008

In this study, the social theory of identity was used to gain a better understanding of the complex process of how individuals adjust to having insulin-requiring diabetes. Semistructured interviews were conducted with 30 individuals to explore issues related to their personal experience with diabetes. Narrative methods were used to analyze the data. An exploration of participants' stories revealed significant identity issues underlying their interpretation and management of diabetes. The diagnosis of diabetes was conceptualized as an assault on personal identity. This initial disruption was followed by a process of negotiation whereby individuals grappled with identity issues to adapt to the condition and integrate it into their lives. This process was socially shaped and influenced individuals' perceptions of their diabetes management. The main concepts examined in this paper are diagnosis and identity, identity and treatment management, and identity and the ongoing nature of adjustment. The implications for diabetes education are presented.
Assessment and Management of Erectile Dysfunction in Men With Diabetes
Authors: Spollett Geralyn R.
Published: April 2008

PURPOSE

Erectile dysfunction occurs earlier in men with diabetes than in the general population, affecting over 50% of male patients by age 60. This article summarizes the etiologies and presents methods of patient assessment and treatment options for erectile dysfunction.

METHODS

Assessments of neurologic and vascular complications related to diabetes should be included in a sexual function history. The assessment must be holistic and focus on organic as well as psychogenic causes. Diabetes educators must be prepared to discuss the various pharmacologic treatment options.

RESULTS

Sildenafil currently is the only oral medication available for erectile dysfunction. Injectable treatments have proven successful but with limited long-term use and poor patient acceptance. Implantable devices carry surgical risk and increased rates of infection.

CONCLUSIONS

All men with diabetes should be screened for erectile dysfunction. The availability of a new oral medication provides a patient-acceptable treatment option.
Culturally Competent Diabetes Education for Mexican Americans: The Starr County Study
Authors: Brown Sharon A. , Hanis Craig L.
Published: April 2008

PURPOSE

Few culturally competent health programs have been designed for Mexican Americans, a group that bears a disproportionate burden of Type 2 diabetes. In Starr County, a Texas-Mexico border community, investigators designed and tested a culturally competent intervention aimed at improving the health of this target population. The purpose of this article is to describe the development process of this diabetes education and support group intervention.

METHODS

The development stages were (1) community assessment, (2) intervention design, (3) selection or development of outcomes, (4) pilot testing, and (5) a randomized clinical investigation.

RESULTS

Focus group participants identified knowledge deficits regarding diabetes and self-management strategies, and suggested characteristics of an effective intervention for Mexican Americans. Outcome measures included metabolic control indicators, a newly developed knowledge instrument, and an existing health belief instrument. Preliminary analyses indicated that the intervention was successful in significantly improving metabolic control in the target population.

CONCLUSIONS

Developing successful diabetes interventions for minority groups requires a number of stages, careful planning, assessment of cultural characteristics of the target population, and a systematic approach to implementation.
Lispro Insulin: Adsorption and Stability in Selected Intravenous Devices
Authors: Ung Jie , Hu Ming , Hagerup Tore , Campbell R. Keith
Published: April 2008

PURPOSE

The adsorption characteristics and stability profile of an insulin analog, lispro insulin, were evaluated against a recombinant human regular insulin using intravenous infusion sets and syringes.

METHODS

Studies were performed using either 0.9% NaCl or 5% dextrose intravenous injection solution. Effects of container type, infusion rate, product concentration, presence/absence of an in-line filter, and storage condition on release profiles of lispro and human regular insulin infusion solutions were determined.

RESULTS

Lispro insulin and m-cresol were chemically stable. Release rates of insulin (both types) were steady after an initial lag time. The lag time was much longer with intravenous bag infusion than with intravenous syringe infusion. A higher product concentration, faster flow rate, and prewash of the infusion tubing were shown to substantially decrease the lag time.

CONCLUSIONS

The adsorption profile of lispro insulin was the same as that of human regular insulin in both syringes and bags. Use of a load-and-sit prewash scheme may shorten or nearly eliminate the lag time, which in turn may be used to make a more accurate calculation of a patient's dose.
The Diabetes Day Treatment Experiment: A Preliminary Report on What We Learned
Authors: Hendricks Leo E. , Hendricks Rosetta T. , Young Anne L.
Published: April 2008

PURPOSE

this paper presents data on the efficacy of a diabetes day treatment program to modify the healthcare behavior of elderly African Americans with diabetes.

METHODS

African American patients with Type 1 or Type 2 diabetes who were referred by their certified diabetes educator were eligible to participate in the day treatment program. The program was designed to serve eight patients for 4 hours 1 day a week over 9 months. Participants engaged in informal discussions, low-impact armchair exercises, and discussions of various diabetes issues. A flow sheet was initiated and maintained by the investigators to record information pertaining to each participant's blood pressure, blood sugar, and weight at each session. Attendance and reasons for not attending sessions were recorded. To obtain more in-depth information, the group leaders used a technique known as participant observation.

RESULTS

Having CDEs administer a blood sugar test, take blood pressure, and weigh each patient at each clinic visit promotes patient adherence to the diabetes treatment regimen. Memory loss was observed to be especially prevalent among the subjects.

CONCLUSIONS

The Diabetes Day Treatment Program may be used as a model for working with elderly persons with diabetes from different ethnic groups.
Foot Education Improves Knowledge and Satisfaction Among Patients at High Risk for Diabetic Foot Ulcer
Authors: Ward Aileen , Metz Louise , Oddone Eugene Z. , Edelman David
Published: April 2008

PURPOSE

The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer.

METHODS

We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program. Two sessions were conducted by a nurse diabetes educator 3 months apart. Multiple educational approaches were used to teach patients foot self-examination, foot washing, proper footwear, and encouragement in enlisting proper physician foot care. Knowledge and satisfaction with care was measured before and after each visit.

RESULTS

The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program. After the second session, the mean improvement over baseline was 14%. These patients also reported improved satisfaction with foot care; mean improvement was 33%.

CONCLUSIONS

An intensive education program improved the foot care knowledge and behavior of high-risk patients. Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program. Ways to improve accessibility of education sessions must be explored.
Comparing Outpatient and Inpatient Diabetes Education for Newly Diagnosed Pediatric Patients
Authors: Siminerio Linda M. , Charron-Prochownik Denise , Banion Carolyn , Schrelner Barbara
Published: April 2008

PURPOSE

the purpose of this study was to compare the efficacy of outpatient vs inpatient programs on medical, cognitive, behavioral, and psychosocial outcomes.

METHODS

Using three large, tertiary medical centers in the United States, the sample of 32 children newly diagnosed with diabetes and their parents were recruited. Children and parents who received outpatient education were compared with those who received inpatient education. The following outcome variables were compared: (1) rates of hospital readmissions and/or emergency room visits for either severe hypoglycemia or ketoacidosis, (2) knowledge, (3) sharing of responsibilities, (4) adherence, (5) family functioning, (6) coping, and (7) quality of life.

RESULTS

In general, no statistically significant differences were found between the groups. A trend was noted in the outpatient group with regard to improved use of emergency precautions on the adherence measure, roles on the family functioning measure, maintaining family integration on the parental coping measure, and disposition on the children's coping instrument.

CONCLUSIONS

Findings support the safety and efficacy of the outpatient program method.
Use of Lispro Insulin and Quality of Life in Adolescents on Intensive Therapy
Authors: Gray Margaret , Boland Elizabeth A. , Tamborlane William V.
Published: April 2008

PURPOSE

this study examined the metabolic and quality-of-life effects of using lispro insulin in teenagers.

METHODS

Teenagers on multiple daily injections who had not reached metabolic treatment goals were offered the opportunity to use lispro insulin as part of a larger ongoing study of intensive management in youth. Of the 51 who were eligible, 35 used lispro and were followed for 12 months; the remaining 16 had reached treatment goals, were not offered lispro, and comprised the control group.

RESULTS

After 12 months, the teens who received lispro insulin achieved equivalent levels of metabolic control to those achieved by teens in the control group, without differences in total daily dose, insulin regimen, or adverse events. Those who received lispro found coping with diabetes less difficult than those who continued on regular insulin, and they reported less negative impact of diabetes on quality of life and fewer worries about diabetes. Both groups were equally satisfied with their diabetes treatment.

CONCLUSIONS

Lispro insulin is a safe alternative for youth on intensive regimens, may assist youth in coping with diabetes, and may improve their quality of life.
Characteristics of the Adult Learner
Authors: Walker Elizabeth A.
Published: April 2008

PURPOSE

This article provides an overview of adult learner characteristics, with an emphasis on those characteristics studied in diabetes patient education research.

METHODS

A selected review of the conceptual and research literature on general adult education and adult learning was conducted, with particular attention to diabetes patient education studies.

RESULTS

Characteristics reviewed included learning styles, literacy level, age/aging, ethnicity or culture, gender, and knowledge. Studies of the learning style of group vs individual education indicated some positive benefits for group learning; questions remain about optimal size or periodicity. Studies evaluating the benefits of culturally specific interventions for diabetes management have yielded some information. Characteristics related to gender and age have been studied, but often in pilot or feasibility studies without the power to answer the study questions.

CONCLUSIONS

There continue to be many gaps in knowledge related to adult learner characteristics in diabetes education. Lessons from both general adult learning literature and patient education literature from other chronic diseases should be evaluated and incorporated. The complexities of these learner characteristics create challenges in designing studies. However, evidence to support the need for effective educational interventions is of great importance for implementing change in health care.