Diabetes Education Centre Research Articles

Challenges of a pharmacist-directed peer support program among adolescents with diabetes

ObjectivesTo describe the development and challenges of a pharmacist-directed peer support program among adolescents with diabetes. Practice DescriptionThe program was designed as adjunctive therapy for adolescents receiving care at the Diabetes Education and Research Center (DERC). DERC is an interdisciplinary facility at which the clinical pharmacist provides direct, diabetes-related patient care services. Through collaboration with DERC, pharmacists developed and facilitated each component of the program. Practice InnovationThe U.S. Diabetes Conversation Map program was used for the educational component of the program. This is an innovative, American Diabetes Association–approved tool for providing group education on diabetes self-management. As trained facilitators of the conversation maps, the investigators educated group leaders on how to be facilitators for their peers. Main Outcome MeasuresGlycosylated hemoglobin (A1C), diabetes self-management skills, and diabetes-related quality of life were measured at baseline and following program completion. Qualitative outcomes were measured via validated questionnaires in adolescents with type 1 diabetes. The investigators facilitated the gathering of all quantitative and qualitative data. ResultsSeveral participants did not meet all inclusion criteria; therefore, data from only six participants were assessed. A1C increased among participants, affirming the challenge of metabolic control during adolescence. Despite this, qualitative analysis of questionnaires revealed improvements in adherence to lifestyle modifications and health perception after program completion. ConclusionEvidence illustrates beneficial effects of peer-facilitated support on the physical and psychological challenges of diabetes self-management; however, challenges existed when implementing this program among adolescents. Suggestions to overcome these challenges include same-sex support groups, use of an appealing setting for participants, incorporation into camps or after-school programs, and extended program length. Pharmacists are well equipped to assist individuals in comprehensive diabetes management programs such as the one described here because of their education and training in medication management, therapeutic lifestyle changes, and patient communication.

A Culturally Sensitive Diabetes Peer Support for Older Mexican‐Americans

The purpose of this study was to determine if a peer-led diabetes support group intervention could improve adherence to recommendations for self-management in 42 Mexican-American elders with type 2 diabetes. This mixed-method pilot study occurred at a community-based diabetes education centre in Texas. The 10-week intervention programme was compared to usual care on five self-reported questionnaires and blood tests during four collection periods. Participants displayed statistically significant improvements in blood sugar, self-efficacy, transformational change and personal resources. Qualitative themes were derived from 30 focus group meetings, which were as follows: do not trust the system, choice + control = power and the social cost of diabetes. The results suggested a consultation role for occupational therapists in training peer leaders to learn to lead and manage community-based diabetes self-management programmes. Limitations were the sample size of the convenience sample, and the lack of qualitative analysis of the control group discussions. Future research should involve a study of expanded community-based social networks using experimental design.

Profiles of smokers and non-smokers with type 2 diabetes: Initial visit at a diabetes education centers

Aims This study explores differences in psychosocial, behavioral and clinical characteristics among smoking and non-smoking individuals with diabetes attending diabetes education centers (DEC). Methods A questionnaire was administered to 275 individuals with type 2 diabetes attending two DECs between October 2003 and 2005. The participants’ characteristics were analyzed and multivariable linear and ordinal regressions were performed to adjust for variables correlated with smoking. Results Findings revealed that smokers, compared to non-smokers, had lower outcome expectations of the benefits of self-management, lower diastolic blood pressure, and followed their recommended diet and tested blood glucose levels less often than non-smokers. Smokers also had lower intentions to use resources outside and within the DEC. Conclusions Results demonstrate poorer self-care behaviors among smokers compared to non-smokers and further suggest cognitive and behavioral differences between smokers and non-smokers regarding participation and attitudes toward self-management practices. These findings identify issues that need to be addressed in diabetes self-management programs to allow for more effective interventions tailored to the healthcare needs of this specific population.

Telehealth in Rural Montana: Promoting Realistic Independent Self-Management of Diabetes

Fondly known as “the last best place,” Montana ranks 44th nationally in state population, fourth in land mass, and third for lowest population density in the United States.1 The state has only three counties with a population > 50,000; 53 of its 56 counties are defined as rural.2 Primary care providers (PCPs) who provide the bulk of diabetes care in rural areas experience multiple challenges, including limited health care resources, geographic isolation, and limited access to diabetes education centers.3 Diabetes is a prevalent and costly disease with significant morbidity and mortality.4 New health care delivery strategies to increase rural patients' access to care are needed. Billings Clinic (BC) is a 272-bed hospital and 225-physician regional multi-specialty group practice. Through its Eastern Montana Telemedicine Network (EMTN), BC provides telehealth care to patients living in rural areas in eastern Montana and parts of Wyoming and the Dakotas. The BC Center for Clinical Translational Research (CTR) was established in 1999 to help promote healthier living and improve management of chronic disease. In 2002, CTR, in collaboration with EMTN, initiated a diabetes management project called Promoting Realistic Individual Self Management (PRISM) to enhance diabetes care in rural communities. The 4-year project study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The objective of the PRISM project was to implement and evaluate the effectiveness of a nurse practitioner–led multidisciplinary team approach to enhance diabetes care through patient empowerment and improved self-management in close conjunction with patients' PCPs in both urban and rural settings. The goals were to achieve American Diabetes Association (ADA) standards5 for vascular risk factor control and to improve patient self-management skills and patient satisfaction. This article describes the design and implementation process of the telehealth component of the PRISM program and selected …

Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes

hart pl & grindel cg (2010) Journal of Nursing and Healthcare of Chronic Illness2, 225–240 Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetesAim. To examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of self‐care behaviour and A1c levels in individuals with type 2 diabetes.Background. Diabetes mellitus affects 23·6 million Americans and is the seventh leading cause of death in the United States. Reduction in complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control. Understanding the degree of influence that psychosocial factors have on individuals’ decisions to perform self‐regulation activities will give insight on strategies to encourage better decision‐making to prevent acute and chronic complications.Methods. A descriptive, correlational design examined the psychosocial factors to determine the predictive relationships with self‐care behaviour and A1c levels. Participants were 119 men and women recruited from physician offices, medical clinics, and diabetes education centers. The research was conducted from March–December 2007.Results. Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analyses revealed that a) coping efficacy uniquely accounted for 9% of the variance in self‐care behaviour and b) illness representations, particularly timeline‐cyclical, uniquely accounted for 12% of the variance in A1c levels.Conclusions. The findings confirm how illness representations, emotional distress, coping strategies, and coping efficacy influence self‐care behaviour and health outcomes. Psychosocial factors can influence lifestyle behaviour changes and outcomes of individuals with diabetes mellitus.Relevance to clinical practice. Findings from the study have implications for nurses in the areas of assessment, diabetes management, coping skills training, and cognitive behavioural therapy. Nurses should incorporate these strategies into their daily practice to help individuals identify successful coping strategies, enhance coping efficacy, and change misconceptions about diabetes mellitus to improve self‐care behaviour and health outcomes.

The impact of diabetes education on blood glucose self‐monitoring among older adults

To determine whether attending diabetes education is associated with blood glucose self-monitoring among unselected older adults in routine clinical care. A cross-sectional population-based study was carried out on 15,190 people with diabetes aged 65-79 years. Subjects were identified using a registry of doctor-diagnosed diabetes derived from administrative data, and attendance at diabetes education centres (DECs) was determined from a separate registry of DEC utilization for 2006. Outcomes were derived using administrative data. The primary outcome was prescriptions filled for glucose self-monitoring supplies. The secondary outcomes were prescriptions for antihypertensive drugs, prescriptions for lipid-lowering drugs and eye examinations. DEC attendance was associated with glucose self-monitoring, after adjusting for baseline differences between attendees and non-attendees (adjusted odds ratio 6.45, 95% confidence interval 5.61 to 7.42). All of the secondary outcomes were also independently associated with DEC attendance. This study suggests that diabetes education is associated with self-management behaviour in real-world clinical care. These findings support the effectiveness of self-management education programmes to increase self-care behaviours.

Identification of Two New Mutations in the Glucokinase Gene That Result in Maturity-Onset Diabetes of the Young

Glucokinase catalyzes glucose to glucose-6-phosphate conversion in the pancreatic β-cell and is a key regulator of insulin secretion (1). The glucokinase gene ( GCK ) on chromosome 7p15.3–15.1 has 12 exons. GCK heterozygous inactivating mutations result in mild fasting hyperglycemia termed maturity-onset diabetes of the young type 2 (MODY2) or MODY-GCK (MIM # 125851) (2). The mutations result in diminished insulin secretion (3) and possibly decreased hepatic glucose uptake and glycogen synthesis (4). Several hundred inactivating mutations throughout exons 2 to 10 have been described (5). We report two previously undescribed mutations. Both patients were assessed at the Pediatric Diabetes Education Centre, Stollery Children's Hospital, Edmonton, Canada. Glucose and A1C …

Teaching so they hear: Using a co‐created diabetes self‐management education approach

To describe the development and outcomes of a co-created diabetes self-management education (DSME) intervention that resulted in statistically significant (p=.02) improvements in diabetes self-care activities when compared to outcomes of a typical DSME program. In this pilot study, an experimental self-management intervention with a self-selected group of adults with type 2 diabetes mellitus was held in the southern United States. Focus group results were used to develop the intervention and DSME participants co-created the sessions. Pre- and postintervention outcomes were compared to those of participants in DSME programs at two area, certified diabetes education centers. No significant differences were found between the experimental and control groups with regard to knowledge, adaptation, and program satisfaction. However, diabetes self-care activities significantly improved (p=.02) for the experimental group. A co-created teaching approach better meets the learning needs of adults with type 2 diabetes mellitus and results in enhanced ability to perform the self-care activities required for successful diabetes control. Better diabetes control reduces visits to monitor and treat complications and the need for repetitive educational sessions that exceed third-party pay limits and extend the time needed for patient encounters.

Errors in patient perception of caloric deficit required for weight loss—observations from the Diet Plate Trial*

Persons with obesity may be poor estimators of caloric content of food. Health care professionals encourage patients to consult nutritional labels as one strategy to assess and restrict caloric intake. Among subjects enrolled in a weight loss clinical trial, the objective is to determine the accuracy of subjects' estimates of caloric deficit needed to achieve the desired weight loss. A 6-month controlled trial demonstrated efficacy of a portion control tool to induce weight loss in 130 obese people with type 2 diabetes. All subjects had previously received dietary teaching from a dietician and a nurse. At baseline, patients were asked how much weight they would like to lose and to quantitatively estimate the caloric deficit required to achieve this weight loss. The stated amount of weight loss desired ranged from 4.5 to 73 kg, with an average of 26.6 kg (n = 127 respondents). Only 30% of participants were willing to estimate the required caloric deficit to lose their target weight. Subjects' per kilograms estimate of caloric deficit required ranged from 0.7 to 2,000,000 calories/kg with a median of 86 calories/kg. Nearly half of subjects (47.4%) underestimated the total required caloric deficit to achieve their target weight loss by greater than 100,000 calories. Despite attendance at a diabetes education centre, this population of obese individuals had a poor understanding of the quantitative relationship between caloric deficit and weight loss. Educational initiatives focused upon quantitative caloric intake and its impact on weight change may be needed to assist obese patients in setting appropriate weight loss goals and achieving the appropriate daily caloric restriction required for success.

Continuous Glucose Monitoring Technology for Personal Use

The purpose of this article is to describe the development and implementation of an educational program for the initiation of real-time continuous glucose monitoring (CGM) technology for personal use, not 3-day CGMS diagnostic studies. The education program was designed to meet the needs of patients managing their diabetes with either diabetes medications or insulin pump therapy in an outpatient diabetes education center using a team-based approach. Observational research, complemented by literature review, was used to develop an educational program model and teaching strategies. Diabetes educators, endocrinologists, CGM manufacturer clinical specialists, and patients with diabetes were also interviewed for their clinical observations and experience. The program follows a progressive educational model. First, patients learn in-depth about real-time CGM technology by attending a group presensor class that provides detailed information about CGM. This presensor class facilitates self-selection among patients concerning their readiness to use real-time CGM. If the patient decides to proceed with real-time CGM use, CGM initiation is scheduled, using a clinic-centered protocol for both start-up and follow-up. Successful use of real-time CGM involves more than just patient enthusiasm or interest in a new technology. Channeling patient interest into a structured educational setting that includes the benefits and limitations of real-time CGM helps to manage patient expectations.

DreamTel; Diabetes risk evaluation and management tele-monitoring study protocol.

BackgroundThe rising prevalence of type 2 diabetes underlines the importance of secondary strategies for the prevention of target organ damage. While access to diabetes education centers and diabetes intensification management has been shown to improve blood glucose control, these services are not available to all that require them, particularly in rural and northern areas. The provision of these services through the Home Care team is an advance that can overcome these barriers. Transfer of blood glucose data electronically from the home to the health care provider may improve diabetes management.Methods and designThe study population will consist of patients with type 2 diabetes with uncontrolled A1c levels living on reserve in the Battlefords region of Saskatchewan, Canada. This pilot study will take place over three phases. In the first phase over three months the impact of the introduction of the Bluetooth enabled glucose monitor will be assessed. In the second phase over three months, the development of guidelines based treatment algorithms for diabetes intensification will be completed. In the third phase lasting 18 months, study subjects will have diabetes intensification according to the algorithms developed.DiscussionThe first phase will determine if the use of the Bluetooth enabled blood glucose devices which can transmit results electronically will lead to changes in A1c levels. It will also determine the feasibility of recruiting subjects to use this technology. The rest of the Diabetes Risk Evaluation and Management Tele-monitoring (DreamTel) study will determine if the delivery of a diabetes intensification management program by the Home Care team supported by the Bluetooth enabled glucose meters leads to improvements in diabetes management.Trial RegistrationProtocol NCT00325624

Community Pharmacist–Provided Extended Diabetes Care

Pharmacists in various settings have been effective in initiating diabetes treatment. Patients with diabetes require ongoing disease management, and community pharmacists are in a strategic position to provide such extended care. Little is known, however, about the effects of community pharmacist-provided interventions beyond the initial treatment period. To evaluate the effect of community pharmacist-provided extended diabetes care service on primary clinical outcomes, including hemoglobin A(1c) (A1C), low-density lipoprotein cholesterol (LDL-C), and blood pressure, and on patients' reported self-care activities. A randomized controlled trial was conducted in patients with diabetes. Participants had already completed at least 2 diabetes education sessions at a local diabetes education center. Nine specially trained pharmacists administered interventions during up to 4 quarterly visits per patient. Interventions included discussing medications, clinical goals, and self-care activities with patients and recommending medication changes to physicians when appropriate. The main outcome measures were 12-month changes in A1C, LDL-C, blood pressure, and self-report of self-care activities. Seventy-eight patients participated in the study (36 intervention, 42 control); 66 were included in the final analysis (31 intervention, 35 control). Compared with changes in the control group, patients who received interventions significantly increased the number of days per week that they engaged in a set of diet and diabetes self-care activities (1.25 and 0.73 more days/wk, respectively). The mean 12-month changes for A1C, LDL-C, and blood pressure were not significantly different between the 2 study groups. Although pharmacist-provided interventions did not demonstrate statistically significant improvements in clinical outcomes over the study period, study results did show that pharmacists were effective at increasing the number of days that patients spent engaging in healthy diet and diabetes self-care activities. Addressing lifestyle and self-care behaviors can be a beneficial component of a pharmacist-provided extended diabetes care service.

Diabetes in Africa: lessons from two lived experiences

aims: Explore challenges and triumphs of managing diabetes in Tanzania, • Africa, June-July 2008, while a student with the International Tanzania Study Tour, Dalhousie University, Canada; Building on experiences in The Gambia, Africa, July-September • 2006 in developing and implementing diabetes education and prevention program, the lived Gambian diabetes experience is compared, contrasted to the lived Tanzanian diabetes experience; Relate similarities and differences from the African visits to clinical • interactions as a Diabetes Case Management Coordinator in Nova Scotia, Canada, and how practice has changed as a result; Present a personal picture of the growing epidemic in Africa; • Discuss the success of community based organizations (CBOs) in • Tanzania in HIV testing, education and prevention and nutritional, financial, and spiritual support; Apply lessons learned and insights obtained from Gambian and • Tanzanian travels to personal and professional growth as a nurse and global citizen; Methods: Anecdotal, informal interviews with individuals living with • diabetes in Tanzania; Discussion with healthcare professionals about managing diabetes • in Tanzania, hospital and community, (monitoring blood glucose, using medications, adhering to a “diabetic diet”); Personal reflection, journal writing; • Literature review: managing diabetes in a resource-poor • environment; Culture immersion: language, food, social connectedness; • results: The lived experience of diabetes in Tanzania and The Gambia • is similar to lived experience in Nova Scotia, Canada, despite differences in geography, economics and culture; Diabetes is a chronic disease affecting individuals, families, and • communities because it is largely managed by diet and lifestyle, and thereby greatly influenced by culture and socioeconomics; Living in a resource-rich environment did not always ensure good • glycemic control, and likewise, reasonable glycemic control is achievable in a resource-poor environment; Support (family, healthcare team, and community) are key elements • for success in both a resource-poor and -rich environment; Discussion/conclusion: Diabetes: a chronic disease, a global epidemic. Educating, • preventing and managing diabetes in Africa impacts the world, as educating, preventing and managing AIDS in Africa impacts the world; Diabetes education centres in Tanzania are a successful model of • care for resource-poor nations to follow; Adapting AIDS CBOs to diabetes is one community-minded • strategy to prevent, educate and manage the diabetes epidemic, for resource-poor and rich environments; The world is a small place, we are all connected, and our • commonalities are greater than our differences. We are all human;

Intervention and Education in Diabetes: A Pilot Project Comparing Usual Care with Pharmacist-Directed Collaborative Primary Care

Background: Prior to this project, patients were required to drive up to 2 hours to a diabetes education centre. As a result, many patients were not receiving diabetes education, and there was little or no follow-up of patients. Significant opportunity exists for pharmacists to fill such gaps in chronic disease management services. Methods: Patients were randomly assigned to the intervention or usual care arm. Laboratory data (glycosylated hemoglobin, fasting blood glucose, lipid panel, microalbumin, systolic and diastolic blood pressure) and Diabetes Empowerment Scale short form (DES-SF) score were collected at baseline and at 6 months. Intervention patients received a medication review, 3 one-on-one education sessions with one of the study pharmacists and follow-up phone calls. Usual care patients did not receive medication reviews or education sessions, and received follow-up phone calls only if drug-related problems were detected. Drug-related problems were tracked for all patients. Referrals to other health care professionals (dietitian, homecare, public health) were made as required. Paired-sample t-tests were used to compare baseline and 6-month data. Results: Forty-five patients were enrolled in the study (intervention: 23; usual care: 17). Five patients were lost to follow-up (intervention: 2; usual care: 3). There was a statistically significant improvement in DES-SF score in the intervention group ( p < 0.001) and a decline in DES-SF score in the usual care group ( p < 0.04). There was a significant decrease in glycosylated hemoglobin in the usual care group ( p < 0.04). Referrals to other health care professionals were higher in the intervention group (I: 36; UC: 0). The number of drug-related problems detected was also greater in the intervention group (I: 83; UC: 8). The overall acceptance rate of pharmacist recommendations for drug-related problems was high in both arms (I: 81%; UC: 100%). Conclusions: Most outcome measures were not statistically significant. Further study is needed to evaluate the change in clinical outcomes. However, greater involvement of a pharmacist in diabetes management resulted in greater detection of drug-related problems and referral to other health care professionals, and promoted diabetes-related self-efficacy and appropriate self-care behaviour. Pharmacists can play an important role in the management of diabetic patients.

Predictors and effectiveness of diabetes self-management education in clinical practice

Objective To describe the demographic and clinical predictors of attendance at a diabetes education center (DEC) for self-management education, and to compare subsequent quality of care indicators between attendees and non-attendees. Methods DEC attendance in 2002 was determined from a written questionnaire completed by 781 adults with diabetes across Ontario, Canada. Predictors of attendance and quality of care indicators were defined from the questionnaire and from linkage with health care administrative data. A multivariate logistic regression model was built to find the independent predictors of attendance, while quality of care was evaluated using propensity score methods. Results 30% of survey participants reported attending a DEC in 2002. Independent predictors of attendance were shorter duration of diabetes, receiving regular primary care, receiving regular diabetes specialist care and single marital status. Attendees were more likely to receive a retinal screening examination in the following 2 years than non-attendees. Conclusion Receiving regular primary care was the strongest predictor of attending a DEC, suggesting that DECs are not substitute providers of diabetes care for people without a regular physician. Increased retinal screening among DEC attendees suggests that self-management education improved their self-efficacy to ensure adequate screening was performed. Practice implications The findings characterize the types of people who attend DECs, which may lead to identification and targeting of inequities in access. The findings also highlight the influence diabetes education can have on quality of care in real-world practice.

A psychosocial taxonomy of patients with diabetes: validation in a primary care setting

The aims of this study were (i) to extend a psychosocial taxonomy of patients with diabetes to a primary care setting, and (ii) to validate the taxonomy using more sophisticated clustering methods across an array of psychological dimensions independent of demographic and medical variables. In a cross-sectional study, 111 adults with Type 2 diabetes seen in a primary care setting completed the Multidimensional Diabetes Questionnaire and the Brief Symptom Inventory (BSI). They also provided diabetes-specific self-report measures along with HbA(1c). Four psychosocial patient profiles were identified using model-based cluster analysis in a US primary care setting. The four profiles represent a replication of two and refinement of a third profile found previously in French-speaking patients at diabetes education centres. Validation of the profiles using the BSI was replicated for depression and extended to other psychological dimensions. The validity and distinctiveness of the four psychosocial profiles were independent of demographic and diabetes-specific medical variables. Replication and extended validation of the psychosocial taxonomy into primary care may allow healthcare workers to supplement medical treatments with psychosocial interventions that can improve outcomes for patients with diabetes that are practical, individually tailored, and cost-effective.

Conversation Maps in Canada: the First 2 Years

Gladys developed type 2 diabetes at age 58. She was concerned when the doctor told her to go to the local diabetes education center (DEC) to learn about diabetes because she had never done well in school. In fact, she disliked school and did not want to get back into a school setting. The DEC secretary told her she would be there for about 2 hours and that she would be with a small group of people who had also just been diagnosed with diabetes. When Gladys arrived and saw the Conversation Map on the table, she thought, “Oh, it's a game.” The educator explained that it was not a game, but rather a tool to help stimulate and focus discussion. Although the group started out very quietly, Gladys found that after the first few questions, she and the others were all interacting. She discovered that she actually did know some things about diabetes, but she also realized she learned many new things. One woman in the group lived near her, so they decided they would go for a walk together on the weekend. At the end of 2 hours, Gladys said, “That was a nice way to learn about diabetes. I was afraid we were going to be lectured at and told what to do. I met people in the same situation and who have the same worries I do. It was good to see that I am not alone.” Conversation Maps are tools used to generate discussion and encourage self-reflection and sharing of the experience of living with diabetes. They are not a game, but they do provide a visual platform to engage participants and allow them to discover facts about diabetes for themselves. Conversation Maps are usually used with small groups led by a facilitator who may …

Factors contributing to attrition behavior in diabetes self-management programs: a mixed method approach.

BackgroundDiabetes self-management education is a critical component in diabetes care. Despite worldwide efforts to develop efficacious DSME programs, high attrition rates are often reported in clinical practice. The objective of this study was to examine factors that may contribute to attrition behavior in diabetes self-management programs.MethodsWe conducted telephone interviews with individuals who had Type 2 diabetes (n = 267) and attended a diabetes education centre. Multivariable logistic regression was performed to identify factors associated with attrition behavior. Forty-four percent of participants (n = 118) withdrew prematurely from the program and were asked an open-ended question regarding their discontinuation of services. We used content analysis to code and generate themes, which were then organized under the Behavioral Model of Health Service Utilization.ResultsWorking full and part-time, being over 65 years of age, having a regular primary care physician or fewer diabetes symptoms were contributing factors to attrition behaviour in our multivariable logistic regression. The most common reasons given by participants for attrition from the program were conflict between their work schedules and the centre's hours of operation, patients' confidence in their own knowledge and ability when managing their diabetes, apathy towards diabetes education, distance to the centre, forgetfulness, regular physician consultation, low perceived seriousness of diabetes, and lack of familiarity with the centre and its services. There was considerable overlap between our quantitative and qualitative results.ConclusionReducing attrition behaviour requires a range of strategies targeted towards delivering convenient and accessible services, familiarizing individuals with these services, increasing communication between centres and their patients, and creating better partnerships between centres and primary care physicians.

Including Insulin Dose Adjustment in the Scope of Practice for Registered Nurses: Defining Competencies and Educational Requirements.

Insulin Dose Adjustment (IDA) and teaching clients to self adjust insulin are necessary components of diabetes management and education. In Canada, insulin dose adjustment by Registered Nurses (RN) has traditionally been treated as a transfer of function from medicine. Anecdotal evidence as well as a survey of Diabetes Educators in British Columbia (BC) suggests a wide range of practice expectations of nurses assuming this responsibility. RNs in some Diabetes Education Centres are “certified” by their employing agency to adjust insulin under the supervision of a medical doctor.

A Pilot Study of Physical Activity Education Delivery in Diabetes Education Centres in Ontario

To explore physical activity (PA) education delivery in Ontario Diabetes Education Centres (DECs). Semistructured telephone interviews were conducted with diabetes educators involved in PA education from 26 (55%) of 47 eligible centres. Frequency analysis was used to assess responses to closed questions, and qualitative analysis was used to investigate spontaneous comments about PA education content and delivery. Respondents were 61.5% registered nurses, 23% registered dietitians, 7.7% kinesiologists and 7.7% others. All (100%) reported doing something to address PA education, including the following: exercise prescription (73%), PA-specific behavioural counselling (88%), PA follow-up (77%) and providing written materials (92%). However, a substantial proportion of educators did not feel comfortable with their own skills and training in this area. There is a lack of standardization in the content and delivery of PA education in Ontario DECs, and many diabetes educators feel that they lack the skills and training related to PA counselling.