Nursing Interventions for Glycemic Control

Study Overview
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Brief Summary
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Introduction: Diabetes mellitus (DM) is a very frequent pathology, which can lead to renal failure and the need for renal replacement therapy. In people with chronic kidney disease (CKD) and diabetes mellitus (DM), glycemic control is very important for the prevention of microvascular injury. In this context, the Nursing Process (NP) is the instrument to guide care, contributing to the attention of individuals' needs. Objective: To evaluate the results of Nursing Outcomes Classification (NOC), obtained through interventions of the Nursing Interventions Classification (NIC) for the glycemic control, in patients with diabetes in renal replacement therapy, with a diagnosis of Unstable Glycemia, of the North American Nursing Diagnosis - International (NANDA-I). Method: Randomized clinical trial in three dialysis services in southern Brazil. Population: Type I and II diabetes patients on hemodialysis. Sample: Over 18 years old, literate, who accept to participate in the study by signing a Term of Consent Free and Clarified. Exclusion criteria: severe uncorrected deficiency in hearing, speech, total amaurosis, degenerative neurological diseases, or score less than 20 in the Mini Mental State Examination. Randomization occurred by clusters, considering dialysis shifts. The CG followed routine treatment and guidelines, while the IG received nursing interventions on a monthly basis for 6 months. Variables related to NOC scores and the knowledge, attitude and self-care tests for DM were applied before and after the intervention period. After the intervention period, a washout period of 06 months will occur, after which the variables will be collected.

Detailed Description
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After randomization, the intervention group was assesses by a nurse determining the nursing outcomes (NOC)for the specific nursing diagnosis Unstable glycemia. One educational intervention per month was done: Teaching: individual and Teaching: disease process. Control of hyperglycemia and Control of hypoglycemia. Teaching: prescription drugs (prescription drugs, was carried out focusing on oral hypoglycemic agents and insulin) Teaching: psychomotor skills ( was performed with a view to the management and application of insulin). In case of use oral antiglycemic agent the Teaching: prescription drugs and control of hyperglycaemia and hypoglycemia was repeated Teaching: Foot care. Teaching: activity / prescribed exercises. After the completion of the six intervention patients were assessed for outcome classification the study will contemplate a 6 months washout between the NOC assessment ( end of interventions and final assessment)

Official Title
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Nursing Interventions for Glycemic Control

Conditions
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Diabetes Mellitus, Chronic Kidney Diseases

Intervention / Treatment
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* Other: Educational


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diabetic with chronic kidney disease on hemodialysis over 18 years old literate, who accept to participate in the study by signing a Term of Consent Free and Clarified Exclusion Criteria: severe uncorrected deficiency in hearing, speech, total amaurosis, degenerative neurological diseases, score less than 20 in the Mini Mental State Examination

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control<br>Patients have not received any special intervention, the follow up care was the standard care for the specific clinic | |
| Experimental: Intervention<br>After initial allocation the select patient received six educational interventions selected from Nursing Intervention Classification (NIC) | Other: Educational<br> <br> * Other names: Teaching: activity / prescribed exercises.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Glycemic control - HbA1< 7% | blood sample after NIC interventions | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improve Knowledge assessed by questionaries DKNA | DKNA has 15 multiple choice response items and covers aspects related to the general knowledge of diabetes mellitus. The questions are about basic physiology, food groups and substitutions, DM management in case of complications, and general principles of disease care). The measurement scale used is from 0 to 15. A score (1) is assigned for correct answer and zero (0) for incorrect. Score greater than eight indicates knowledge about diabetes mellitus | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nursing Process, Nephrology Nursing, Education Health