Diabetes Nurse Educator Research Articles

The Vital Role of Diabetes Nurse Educators in Smoking Cessation: A Case Study from Türkiye

The Vital Role of Diabetes Nurse Educators in Smoking Cessation: A Case Study from Türkiye

Clinical and Economic Assessment of MyDiaCare, Digital Tools Combined With Diabetes Nurse Educator Support, for Managing Diabetes in South Africa: Observational Multicenter, Retrospective Study Associated With a Budget Impact Model.

In South Africa, diabetes prevalence is expected to reach 5.4 million by 2030. In South Africa, diabetes-related complications severely impact not only patient health and quality of life but also the economy. The Diabetes Nurse Educator (DNE) study assessed the benefit of adding the MyDiaCare program to standard of care for managing patients with type 1 and type 2 diabetes in South Africa. An economic study was also performed to estimate the budget impact of adding MyDiaCare to standard of care for patients with type 2 diabetes older than 19 years treated in the South African private health care sector. The real-world DNE study was designed as an observational, retrospective, multicenter, single-group study. Eligible patients were older than 18 years and had at least 6 months of participation in the MyDiaCare program. The MyDiaCare program combines a patient mobile app and a health care professional platform with face-to-face visits with a DNE. The benefit of MyDiaCare was assessed by the changes in glycated hemoglobin (HbA1c) levels, the proportion of patients achieving clinical and biological targets, adherence to care plans, and satisfaction after 6 months of participating in the MyDiaCare program. A budget impact model was performed using data from the DNE study and another South African cohort of the DISCOVERY study to estimate the economic impact of MyDiaCare. Between November 25, 2019, and June 30, 2020, a total of 117 patients (8 with type 1 diabetes and 109 with type 2 diabetes) were enrolled in 2 centers. After 6 months of MyDiaCare, a clinically relevant decrease in mean HbA1c levels of 0.6% from 7.8% to 7.2% was observed. Furthermore, 54% (43/79) of patients reached or maintained their HbA1c targets at 6 months. Most patients achieved their targets for blood pressure (53/79, 67% for systolic and 70/79, 89% for diastolic blood pressure) and lipid parameters (49/71, 69% for low-density-lipoprotein [LDL] cholesterol, 41/71, 58% for high-density-lipoprotein [HDL] cholesterol, and 59/71, 83% for total cholesterol), but fewer patients achieved their targets for triglycerides (32/70, 46%), waist circumference (12/68, 18%), and body weight (13/76, 17%). The mean overall adherence to the MyDiaCare care plan was 93%. Most patients (87/117, 74%) were satisfied with the MyDiaCare program. The net budget impact per patient with type 2 diabetes, older than 19 years, treated in the private sector using MyDiaCare was estimated to be approximately South African Rands (ZAR) 71,023 (US $4089) during the first year of introducing MyDiaCare. The results of using MyDiaCare program, which combines digital tools for patients and health care professionals with DNE support, suggest that it may be a clinically effective and cost-saving solution for diabetes management in the South African private health care sector.

The impact of nursing staff education on diabetes inpatient glucose management: a pilot cluster randomised controlled trial

BackgroundAn increasing number of patients in hospital have diabetes, with most of them cared for by non-specialist staff. The effect of diabetes education for staff on patient outcomes, as well as the most effective method of staff education is unclear. Therefore, the aim of this study was to compare diabetes outcomes in medical wards where nursing staff were offered one face-to-face (F2F) session followed by access to online education (online), F2F education only, or standard care (control).MethodsWe conducted a pilot cluster randomised controlled trial involving 16-weeks baseline/rollout followed by a 28-week post-intervention period across three medical wards (clusters) in a Sydney Teaching Hospital. The online ward provided an online competency-based diabetes education program and 1-h F2F teaching from a diabetes nurse educator (DNE), the F2F ward provided four separate 1-h teaching sessions by a DNE, with no additional sessions in the control ward. The primary outcome was length of stay (LOS); secondary outcomes included good diabetes days (GDD), hypoglycaemia and medication errors. Poisson and binary logistic regression were used to compare clusters.ResultsStaff attendance/completion of ≥ 2 topics was greater with online than F2F education [39/48 (81%) vs 10/33 (30%); p < 0.001]. Among the 827/881 patients, there was no difference in LOS change between online [Median(IQR) 5(2–8) to 4(2–7) days], F2F [7(4–14) to 5(3–13) days] or control wards [5(3–9) to 5(3–7) days]. GDD improved only in the online ward 4.7(2.7–7.0) to 6.0(2.3–7.0) days; p = 0.038. Total patients with hypoglycaemia and appropriately treated hypoglycaemia increased in the online ward.ConclusionsThe inclusion of online education increased diabetes training uptake among nursing staff. GDD and appropriate hypoglycaemia management increased in the online education wards.Trial registrationProspectively registered on the Australia New Zealand Clinical Trials Registry (ANZCTR) on 24/05/2017: ACTRN12617000762358.

A Comprehensive Intervention for Promoting Successful Aging Amongst Older People With Diabetes With Below-Normal Cognitive Function-A Feasibility Study.

Background: Older people with diabetes have an increased risk for disability and cognitive dysfunction, which may impede self-care capacity. These are not evaluated routinely in current health systems. In the Center for Successful Aging with Diabetes, patients over the age of 60 undergo multi-disciplinary evaluation days and are provided with an integrated (cognitive, physical, nutritional, and medical) treatment plan. Among individuals with below-normal cognitive function, self-adherence to these recommendations poses a challenge. Thus, the aim of this study was to test the feasibility of a multidisciplinary intervention amongst older people with diabetes with below-normal cognitive function and sub-optimal glucose control.Methods: Patients with a MoCA score under 26 and A1C >= 7.5% participated in a two-arm intervention: (A) a medical intervention: monthly meetings with a diabetes nurse-educator, supervised by a diabetes specialist and study psychologist during which changes in their pharmacological regimen of glucose, blood pressure, and lipid control were made and (B) a cognitive/physical rehabilitation intervention. This arm consisted of (1) an intensive phase-group meetings which included computerized cognitive training, aerobic, balance, and strength exercise, and group discussions and (2) a monthly consolidation phase. Outcomes included change in A1C, change in strength, balance, and aerobic exercise capacity as well as change in quality of life.Results: After 12 months there was a 0.7% reduction in A1C. After 3 months there was a statistically significant improvement in physical indices, including aerobic capacity (6-min walk), balance (FSST) and indices assessing the risk of fall (10-meter walk, time up and go). There was no additional improvement in physical indices between the 3 and 12 month visits. For some of the physical measures, the improvement observed after 3 months persisted partially to the 12-month visit.Conclusions: This feasibility study provides preliminary data that support the efficacy of the complex interventions described. The findings suggest that this older population would require an ongoing “intensive phase” intervention. Larger prospective randomized trials are needed.

An innovative integrated model for improving oral health in the Australian context

Background: Australia has a world-class health care system. Yet the prevalence of tooth decay among 5 year olds (50%), and untreated tooth decay among adults (30%) remains high. 23% of Australian adults have moderate to severe periodontitis (gum disease) and with a rapidly increasing prevalence of type 2 diabetes, the bidirectional association of periodontitis and unstable diabetes is predominantly ignored. Dental treatment addressing the result of the disease process is costly, and does not address the actual causes of disease, or the risk factors associated with these diseases. Objectives: To present an innovative population based preventive approach to primary oral health care that is client and family centred, targeted and co-ordinated, and integrates oral and general health. Methods: North Richmond Community Health (NRCH), an inner urban community health service, in Victoria, Australia, has developed a preventive and risk based innovative model of oral-health care. NRCH serves vulnerable groups, including refugees and asylum seekers, homeless, people living with mental illness, elderly, substance users, Aborigines and Torres Strait Islanders. The team includes the full range of oral health professionals (dental assistants, oral health educators, dental and oral health therapists, dental hygienists, prosthetists) and general health professionals, including general medical practitioners, diabetes nurse educators (DNE) and practice nurses. Employing outreach and education methods, minimally invasive and preventive oral health clinical procedures such as the Hall Technique and Silver Diamine Fluoride are incorporated into the program. Results: A health literacy approach for consumers from first contact ensures preparation for this program. The NRCH model of oral health care and its links with other community services will be presented, highlighting a shift in types of services provided, referrals made and consumer engagement in oral health care. In particular the NRCH developing collaborative model of diabetes and oral health management will be presented. In this model the DNE routinely include the ‘mouth’ as a risk factor to be addressed and enquire about daily oral health routines, last oral health review or oral problems. In addition clients seen in the oral health program are assessed for diabetes risk. Those with a high risk score or established diabetes are referred to the DNE. Conclusion: Through re-orienting workforce, utilising health professionals from different disciplines, and a risk based, person-centred care approach to a population health issue, it is possible to find potentially cost-effective ways of delivering primary preventive integrated health care that includes oral health. Collaboration and consistency of care is enhanced through professionals from different disciplines working together and most importantly, in partnership with the client.

Cost saving with a GP-led integrated health service delivery model for complex chronic disease: an optimal Beacon practice

Health policy internationally is promoting the benefit of delivering complex chronic disease care in the community rather than the hospital setting. The Beacon model is designed as a primary-secondary integrated model of outpatient substitution whereby patients with complex diabetes receive care through a community-based practice where GPs with a special interest (GPwSI) and advanced training in diabetes work alongside an endocrinologist and diabetes nurse educator (DNE). We draw on over a decade of research to sketch a profile of an optimal Beacon clinic in terms of capacity and cost. We measured costs at five study sites: two hospitals and three Beacons and computed the Beacon clinic duration and patient load that minimises the costs of treatment. While the costs varied across sites, an optimal Beacon was found to be a lower cost alternative to usual hospital outpatient care. It costs $4,998 to deliver one optimal clinic of four hours duration with two GPwSI and one endocrinologist treating 14 patients with the DNE employed 3-days/week. This estimate is based on an urban setting in which local patient treatment needs are sufficient to support weekly/fortnightly clinics. The model holds promise as a way to cost-effectively manage complex chronic conditions, while freeing resources in hospital settings to attend to acute and inpatient services. It is delivered via a shared Commonwealth and state funding model, currently an uncommon arrangement for chronic disease management. However, proposed pooled funding arrangements at the local level designed to support better integrated care could provide leverage for the model.

The Gestational Diabetes Group Program.

The purpose of the Gestational Diabetes Group Program (GDGP) was to provide patients with diabetes self-management education that occurs in a supportive, prenatal group care setting. The Centering Pregnancy Interdisciplinary Model of Empowerment and the Chronic Care Model guided the program. The pilot project took place at an urban clinic that cares for a diverse, underserved population. The GDGP, a series of four prenatal group sessions after the diagnosis of gestational diabetes and one postpartum group, used an interprofessional/interdisciplinary approach to care with the groups cofacilitated by certified nurse-midwives, certified diabetes nurse-educators, and other community partners. The program was able to show statistically significant changes in knowledge and empowerment, optimal pregnancy outcomes, and high patient satisfaction.

Accessibility and outcomes from a rural diabetes nurse-educator led self-management program

Objective: To investigate factors associated with access to, and health outcomes of, a diabetes nurse-educator led self-management program for rural Australians with diabetes. Design: Retrospective cohort study. Setting: A rural community-health service with a dispersed catchment of 10,000 population. Subjects: Clients diagnosed with type 2 diabetes mellitus and referred to the program between April 2008 and December 2012. Intervention: A diabetes self-management program comprising an initial assessment, a group education session, and 3, 6, and 12 month clinical reviews. Main outcome measures: Program attendance after referral; and achievement of management goals for HbA1c, BMI, total cholesterol, quality of life and psychological distress. Results: Ninety-four percent (n=219/232) of referred clients attended at least once. Multivariate logistic regression showed that attending at least once was significantly associated with living within 25km of the service. Non-smokers/former smokers, general practitioner-referred clients and those with diabetes management plans were significantly more likely to attend three or more sessions. At 12 months clients showed significant improvements in cholesterol, BMI, quality of life and psychological distress. Conclusion: This study demonstrates that diabetes nurse-educator led self-management programs which adapt to their rural contexts – including geographically dispersed catchment populations and resource constraints – provide highly accessible services meeting the needs of most. Nevertheless, some groups (cigarette smokers, those living furthest from the service) may remain marginalised and less able to access services. Improvements in health outcomes for these clients may require further adaptation of models of care to better target their health care needs.

Peer-to-Peer, Interactive GP Education can Reduce Barriers to Best Practice in Diabetes Management.

IntroductionPerceived difficulties in initiating insulin in patients with type 2 diabetes (T2D) may prevent many general practitioners (GPs) from using insulin even when recommended in guidelines. This paper describes a Royal Australian College of General Practitioners accredited education program on starting insulin in T2D, and its impact on GPs’ attitudes and behavior.MethodsA faculty comprising GPs with diabetes expertise, Credentialed Diabetes Nurse Educators, and endocrinologist developed and implemented the education program. The program content was highly procedure focussed, emphasizing simple, best-practice processes for starting insulin therapy and focussing on multidisciplinary models of care. The highly interactive format of the workshops included peer-to-peer learning, in which education was led by diabetes-experienced GP educators, as well as case study-based approaches and small group discussions. GP attendees were asked to rate their individual confidence and attitudes at the beginning and end of the meeting. In addition, participants (n = 220) from two workshops in 2013 were sent a survey 3 months after the meeting to gauge the longer-term impact on their clinical practice.ResultsSince 2008, more than 2500 GPs have attended the workshops, and report substantial improvements in confidence; after attending, more GPs were willing to start insulin within their practice. Evaluations at 3 months post-meeting indicate that the increased confidence was associated with behavioral changes in the subgroup evaluated at this time (n = 48). Success of this program was attributed to peer-to-peer education, multidisciplinary input, easily implemented best practice procedures and checklists for starting insulin, and constant adjustment of meeting process and content based on feedback and guideline changes.ConclusionA peer-to-peer, interactive GP education program reduced GPs’ perceptions of the difficulties of starting insulin in T2D and achieved changes in attendees’ clinical practice. This education program offers an effective approach to overcome the therapeutic inertia that is too common in diabetes management.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-016-0156-0) contains supplementary material, which is available to authorized users.

Diabetes Care Model in Malaysia

With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse Educators, Dieticians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services. Although we have many such individuals, trained and working independently, these services are fragmented. What is required is coordination and integration of these services to enable patients access, in a timely manner. The Disease Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as to provide key diabetes education, that enable patient-empowerment to improve self care, compliance, and ultimately result in better lives.

SELF-MANAGEMENT EXPERIENCES IN PERSONS LIVING WITH DIABETES MELLITUS TYPE 2

Diabetes mellitus (DM) is a progressive disease which has the potential of negatively affecting virtually all the systems of the body, causing debilitating and life-threatening complications if blood glucose levels are not controlled. A high level of self-management is required in order to control blood glucose levels and prevent or delay the onset of complications which may have severe physical, psychological and financial implications for the individuals and their families.  As no research on the experiences of persons living with the condition was previously conducted in Nelson Mandela Bay, South Africa, a qualitative, descriptive, exploratory and contextual study was conducted between January and April 2009. Nineteen participants from both the private and public health care sectors were recruited making use of purposive sampling. The following themes emerged from the data collection: persons living with DM experience a wide range of emotions on initial diagnosis; gradually they experience an acceptance and acknowledgment of their condition; persons living with DM have definite opinions on the concept of self-management; persons living with DM acknowledge both positive and negative factors which influence self-management and expressed views on how professional nurses can assist them in achieving self-management. Recommendations included allowing persons living with DM to take a leading role in decisions regarding management of their condition. They should make periodic reinforcements of their lifestyle modifications as part of an ongoing patient education process. Qualified Diabetes Nurse Educators should be employed at health care facilities, both in the public and private sector. Finally, specialized courses covering all areas of management of DM should be more readily available to health care workers.

Meeting the needs of Māori with diabetes: Evaluation of a nurse-led service.

IntroductionNurse-led programmes play an important role in providing expert education and management in the primary health care (PHC) of people with chronic illnesses. This study examined how a nurse-led diabetes programme set up by Te Hauora 0 Ngati Rârua, a Maori health provider, was effective in addressing the needs of clients. Effectiveness is viewed from a number of perspectives including: cultural appropriateness, integration with the community, accessibility, consumer participation and satisfaction, and health outcomes. The paper is in four sections: A background on health disparities and Maori, then methods, findings generated from a case study of the Te Hauora 0 Ngati Rârua service, and discussion.BackgroundIn Aotearoa/New Zealand, ethnic inequalities between Maori and non-Maori are the most consistent and compelling inequities in health. For example, Maori die on average 8.2 years younger than non-Maori (Statistics NZ, 2009). Of particular concern is the high Maori mortality from diseases that are amenable to treatment, such as diabetes, which affects Maori at a younger age, leading to higher rates of serious diabetic complications and a mortality rate which is four times higher than for non-Maori (Coppell et al., 2013; Statistics NZ).A focus for the New Zealand health system is to develop acceptable and accessible PHC services to keep people well and out of secondary services. To this end the Government funded 264 Maori organisations to provide affordable health services for their people (MOH, 2011). Kaupapa Maori providers attempt to ensure that client access to health services is unimpeded in cultural, financial or social terms, by offering 'by Maori, for Maori' services that incorporate traditional Maori practices and values (Boulton, Tamehana & Brannelly, 2013). As such, the Te Hauora O Ngati Rârua programme was centred on a Diabetes Nurse Educator role, which provided continuity of care across primary and secondary services. While this PHC nursing role has now been replaced by a generalist chronic disease state management role, the insights gained from the evaluation of this diabetes specific programme remain relevant. The findings are important for all nurses working with people (especially Maori) with any chronic condition.Literature ReviewResearch on disparities in health outcomes between Maori and non-Maori has been largely descriptive, identifying and defining the severity of diabetes within communities and different ethnic groups (Coppell et al., 2013; Lim, Chellumuthi, Crook, Rush & Simmons, 2008; Simmons, Rush & Crook, 2009a), and identifying barriers to accessing care (Baxter, 2002; Simmons, Lillis, Swan & Haar, 2007). Some large intervention studies have been undertaken (Coppell et al., 2009; Simmons et al., 2009b), but little is understood about the delivery and experiences of Maori attending targeted diabetes programmes.A number of studies have evaluated Maori health providers including monitoring client utilisation and satisfaction. Maori were found to access such providers because they were cheaper, geographically closer and offered culturally appropriate services (MOH, 2010; Wilson, 2008). Some researchers have considered contractual and organisational issues for Maori providers (Abel, Gibson, Ehau & Tipene Leach, 2005; Boulton, 2007), while others have described aspects of nurse-led PHC services (Hotu et al., 2010; Riley & Crawford, 2010), and found that nurses are able to spend longer with clients and do opportunistic assessments leading to better outcomes. But no studies have focused specifically on nurse-led diabetes programmes.Numerous international studies have explored the reach and effectiveness of diabetes management interventions and nurse-led services (Laws et al., 2012; Pun, Coates & Benzie, 2009; Smide & Hornsten, 2009), including programmes with indigenous populations and ethnic minorities (Ghosh & Spitzer, 2014; Lawrence, 2008). …

An Intervention to Empower Diabetes Nurse Educators to Address Erectile Dysfunction

Erectile dysfunction (ED) is the most common complication for men with diabetes, and is under-recognized and undertreated. Up to one-third of newly diagnosed men with diabetes have ED at presentation, with 50% of men developing ED within 6 years of their initial diagnosis. ED can have a devastating multidimensional impact on men's lives and decrease quality of life. Despite the important role of diabetes nurse educators (DNE) in supporting their clients' diverse psychosocial needs, research suggests that they fail to address this complication 80% of the time. Among healthcare providers, a lack of awareness, knowledge, comfort and self-efficacy in addressing ED are well-documented barriers to offering clients education and treatment support.

Engaging GPs in insulin therapy initiation: a qualitative study evaluating a support program in the Belgian context.

BackgroundA program supporting the initiation of insulin therapy in primary care was introduced in Belgium, as part of a larger quality improvement project on diabetes care. This paper reports on a study exploring factors influencing the engagement of general practitioners (GPs) in insulin therapy initiation (research question 1) and exploring factors relevant for future program development (research question 2).MethodsWe have used semi-structured interviews to answer the first research question: two focus group interviews with GPs who had at least one patient in the insulin initiation program and 20 one-to-one interviews with GPs who were not regular users of the overall support program in the region. To explore factors relevant for future program development, the data from the GPs were triangulated with data obtained from individual interviews with patients (n = 10), the diabetes nurse educator (DNE) and the specialist involved in the program, and data extracted from meeting reports evaluating the insulin initiation support program.ResultsWe found differences between GPs engaged and those not engaged in insulin initiation in attitude, subjective norm and perceived behavioural control regarding insulin initiation. In general the support program was evaluated in a positive way by users of the program. Some aspects need further consideration: job boundaries between the DNE and GPs, job boundaries between GPs and specialists, protocol adherence and limited case load.ConclusionThe study shows that the transition of insulin initiation from secondary care to the primary care setting is a challenge. Although a support program addressing known barriers to insulin initiation was provided, a substantial number of GPs were reluctant to engage in this aspect of care. Important issues for future program development are: an interdisciplinary approach to job clarification, a dynamic approach to the integration of expertise in primary care and feedback on protocol adherence.Trial registrationClinicalTrials.gov Identifier: NCT00824499

The Insulin Injection Recommendations for Diabetes Educator by Korean Association of Diabetes Nurse Educators

The Insulin Injection Recommendations for Diabetes Educator by Korean Association of Diabetes Nurse Educators

Motivational Interviewing Training: A Pilot Study of the Effects on Practitioner and Patient Behaviour

While Motivational Interviewing (MI) is effective in reducing client problem behaviours, including health-related behaviours, there is little evidence about how MI training enhances practitioner skills. The current pilot study addressed this lack by training two health practitioners (Diabetes Nurse Educators) in MI, and evaluated the effect of MI training on both practitioner and patient behaviour when MI was delivered in a clinical settting, with patients experiencing difficulties with diabetes self-management. Comparisons were made between the practitioners' skills in a baseline condition (Patient Education; PE) and after training in Motivational Enhancement Therapy (MET), a four-session form of MI. At the same time, the effects of the two interventions on patient in-session behaviour were compared. Practitioner and patient data were obtained from transcripts of all PE and MET sessions, which were independently coded using Motivational Interviewing Skills Code therapist and client behaviour counts. Compared with their baseline performance, practitioners, when trained to practice MET, behaved in ways consistent with MI, and this appears to have evoked beneficial in-session behaviour from the patients. These results suggest that the MI training was effective.

Findings from a one-day community diabetes screening and education program by a visiting Certified Diabetes Nurse Educator in Festac town, Nigeria

Findings from a one-day community diabetes screening and education program by a visiting Certified Diabetes Nurse Educator in Festac town, Nigeria

Insulin Treatment of Patients with Diabetes and the Problem of Weight Gain: What Do You Need to Know as a Diabetes Nurse Educator?

Reducing hyperglycemia through effective diabetes management in patients with type 1 or type 2 diabetes can reduce progression or development of diabetic complications: this article examines the need for effective pharmacological therapy while minimizing the risk of weight gain, and the role of advanced practice nurses (APNs) in helping patients with these issues. Insulin therapy is effective, but its potential side effects, including excessive weight gain, can undermine treatment success through adverse physiological consequences and patient demotivation. Educational and practical steps can be taken and therapy choices made that can limit this problem. APNs, working closely with patients who have diabetes, with diabetes nurse educators and with dietitians, have a role to play in weight management. Education concerning medical nutritional therapy and physical activity contributes to the overall care of the patient and effective self-management of diabetes. APNs need to maintain an awareness of insulin options and of other emerging diabetes therapies. Work performed at: Henry Ford Medical Center New Center One Division of Endocrinology, Diabetes, Bone and Mineral Disorders Detroit, MI Funding: The publication of this article has been supported by Novo Nordisk Inc. THE NEED FOR EFFECTIVE PHARMACOLOGICAL THERAPY IN PATIENTS WITH DIABETES Optimal glycemic control is paramount in the treatment of diabetes. Well-known, large-scale studies such as the Diabetes Control and Complications Trial (DCCT) in patients with type 1 diabetes and the United Kingdom Prospective Diabetes Study (UKPDS) or the Kumamoto study in patients with type 2 diabetes have conclusively shown that elevated levels of blood glucose are associated with the occurrence of microvascular complications, such as retinopathy and neuropathy (1, 2, 3). The DCCT was a prospective trial involving 1441 patients with type 1 diabetes randomized to either an intensive (three to four insulin injections/day or insulin pump) or conventional (one to two insulin injections/day) treatment protocol. Those in the intensive group achieved a better level of glycemic control than those in the conventional group (median HbA1c 7.3% vs. 9.1%, respectively; p < 0.001), and this was associated with a reduction of development or progression of microvascular complications of up to 76% (1). In the Kumamoto trial (2) involving 110 patients with type 2 diabetes, a better level of metabolic control was achieved with intensified insulin treatment (three or more insulin injections: rapid-acting insulin at mealtimes and intermediate-acting insulin at bedtime) compared with conventional treatment (two intermediate-acting insulin injections daily), with respective mean HbA1c values of 7.1% and 9.4% (p < 0.001). This improved control was associated with a reduction in risk for retinopathy of up to 76% over 6

Diabetes Nurse Educators and Preconception Counseling

The purpose of this study was to examine the diabetes nurse educator's role, practice, and training in preconception counseling (PC) when caring for adolescents with diabetes. A descriptive, correlational research design, using a cross-sectional survey technique, was used. Subjects were 2003 registered nurse members of the American Association of Diabetes Educators. A survey instrument was developed by the investigator and placed on the World Wide Web. Although most of the diabetes nurse educators were aware of PC, most reported not having received any training in PC and would benefit from this education. Thirty percent of the respondents did not routinely provide PC to their adult female clients, and 40% did not provide this to adolescents. Results of this study suggest that the diabetes nurse educators in this sample would benefit from receiving instruction about PC. The diabetes nurse educators should be trained to provide PC to all female clients with diabetes of childbearing age starting at puberty.

Diabetes Nurse Educators' Prioritized Elder Foot Care Behaviors

The purpose of this study was to identify diabetes nurse educators' perceptions of the most important foot care behaviors for elderly people to enact in daily care. A structured, open-ended questionnaire was mailed to a regionally stratified random sample of 90 diabetes nurse educators. Subjects were asked to identify and rank order 8 foot care behaviors perceived important for elderly people with diabetes to enact daily. Data were transcribed and coded into categories and domains using descriptive content analysis. Forty-seven diabetes nurse educators responded with a total of 346 foot care behaviors perceived important for elders. Twenty-one major foot care behavior content categories were grouped into 4 domains of descending importance: foot/nail care, footwear/shoes, general health, and foot emergencies. Diabetes nurse educators generated a range of baseline data for developing a reliable, valid, and patient foot care knowledge outcome measure to support national diabetes patient education and self-management program guidelines.