Diabetes Nurses Research Articles

The Relationship Between Discomfort Intolerance And the Fear Of Self-Injection And Testing In Patients With Diabetes Using Insulin: A Cross-Sectional Study.

Diabetes is a global problem. Diabetes nurses, in particular, take great responsibility in reducing and controlling the fears of individuals using insulin and increasing their capacity to tolerate discomfort. This study was conducted to examine the effects of the capacity to tolerate discomfort on the fear of self-injection and the status of testing blood glucose levels in patients with type 1 and type 2 diabetes using insulin. This cross-sectional study was conducted between December 2022 and February 2023 with 320 adult patients with type 1 and type 2 diabetes using insulin who were followed up in the Endocrinology and Internal Medicine Clinics of a university hospital in Turkey. The data analysis process included analyses of the frequency, independent-samples t-tests, one-way ANOVA, the Kruskal-Wallis H test, and Pearson's correlation analysis. Data were analysed using the IBM SPSS v27.0 software, considering alpha as 0.05. The mean total Discomfort Intolerance Scale score of the patients was 22.78 ± 6.74, and the mean Fear of Self-Injecting and self-testing was 21.1 ± 6.7. A negative significant correlation was found between the discomfort intolerance levels of the patients and their levels of fear of self-injection and self-testing (p < 0.05). Individuals with a higher capacity to tolerate discomfort have lower levels of fear of self-testing and self-injection. Therefore, the fear of self-testing and self-injection in patients using insulin injections may affect diabetes self-management. Individuals with low tolerance for discomfort should be identified, interventions to increase tolerance in individuals at risk should be planned, and diabetes self-management should be better supported. The reporting of the results of the study adhered to the STROBE guidelines.

7366 Experience and perspectives of healthcare professionals regarding exercise directed guidance in pediatric type 1 diabetes

Abstract Disclosure: H. Reznik: None. A. Brener: None. F. Levy-Khademi: None. J. Yeshayahu: None. D. Pivko-Levy: None. I. Koren: None. O. Pinhas-Hamiel: None. M. Sharkia: None. L. Carmon: None. M. Rachmiel: None. M. Muller: None. L. de Vries: None. M. Cohen: None. Objective: Regular exercise can promote various aspects of health in pediatric type-1-diabetes (T1D). However, the management of exercise can be extremely challenging for the child, their family and the healthcare team involved. Studies suggest that children with T1D perform less than the recommended daily activity and that exercise does not always improve glycemic control. Multiple factors should be accounted for, including among others, the nature of the activity and individual child, as well as the treatment regimen. Proper guidance in preparation for exercise is crucial. We conducted a national study aimed at identifying strengths and limitations of exercise directed guidance (EDG) provided by staff in pediatric T1D clinics in Israel. Methods: Healthcare professionals from 8 pediatric diabetes clinics, including physicians, nurses and dietitians, were recruited. Participants completed an anonimized electronic questionnaire assessing: i) Demographics ii) Timing and content of the guidance provided to pediatric patients with T1D iii) Perceived challenges. Results: Ninety-nine professionals took part in this study, 53 physicians, 24 nurses and 23 dietitians. All reported providing EDG to pediatric T1D patients, 90 (90.9%) include EDG both during the initial post-diagnosis visits and periodically thereafter. However, while 83 (83.8%) reported offering guidance to all patients, 16 (16.1%) indicated guiding only specific children: either those that exercise, those that do not exercise or only those that asked for information. Only 64 (64.6%) reported to have specialized educational materials available in clinic, this varied even within the same clinic. The 3 most prevalent topics reported by participants as “usually included” in EDG, were: immediate effects on glucose (94.9%), adjusting carbohydrates (88.8%) and the equipment required during exercise (86.8%). The 3 least frequently addressed subjects were: addressing principals in planning exercise (28.2%) and involving family and friends (29.2% and 17.1% respectively). Challenges by order of prevalence were insufficient teaching aids, the complexity of the topic, lack of knowledge and insufficient time (reported by 44.4%, 39.4%, 34.3% and 34.3% respectively). The knowledge gap most commonly reported centered on understanding the impact of different types of exercise on blood glucose. Conclusions: Healthcare professionals recognize the importance of exercise in T1D management and all of them incorporate EDG in their routine practice. Interestingly, there is considerable variability in both timing and content of the EDG provided, even within the same clinic. We have identified important areas for improvement, with particular attention needed in increasing the availability of educational tools and enhancing staff knowledge. Our findings can assist in creating educational aids for both staff and patients. Presentation: 6/2/2024

Reflection tools – support for patient learning in group education

ABSTRACT This qualitative study describes how reflection can be supported by using reflective tools in group education in type 2 diabetes. The changed conditions for living with a long-term illness may lead to increased anxiety and new demands that affect one’s current life situation. The didactic model, ‘The challenge – to take charge of one’s life with long-term illness’, has been developed into ‘Taking responsibility in life with type 2 diabetes – a model for group education in primary care’. Specialized diabetes nurses and dieticians received training, a manual and continuous guidance in applying the model. Reflection diaries, notes and interviews both from the patients and the caregivers were analyzed using a phenomenological hermeneutic method. The results show that using images as reflective tools engages thoughts and feelings in a way that appears to be important for one’s learning in life with a chronic illness. The images contribute to allowing a distance from one’s situation, actions, thoughts and feelings, which seems fruitful for investigating and discovering new ‘things’ about oneself. With the support of reflective tools and guiding questions, reflection is led to a deeper existential level where both caregivers and patients contribute by asking questions that support the reflection process.

Monitoring handgrip strength to motivate lifestyle choices for patients with diabetes type 2 – a pragmatic randomised controlled trial

Physical strength can be an important parameter to monitor for patients with diabetes mellitus type 2 (T2DM) to promote healthy lifestyle choices. Functional measurements can contribute to healthcare advice and possibly motivate more active lifestyles. The aim of the study was to investigate whether adding measurement and feedback concerning handgrip strength (HGS) to the parameters measured for patients with T2DM at annual check-ups leads to change in physical activity (PA) level, HGS, HbA1c or waist circumference. Methods Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires. Results Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels. Conclusions Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function. ClinicalTrials registration: NCT03693521

Trends and prospects in nursing care for diabetic foot: A bibliometric analysis from 2003 to 2023

BackgroundsDiabetic foot (DF) is a globally significant concern, with complications like diabetic foot ulcers (DFUs) posing major challenges despite medical advancements. Effective nursing strategies are crucial to preventing DF progression and reducing disability risk. However, nursing research in DF care is fragmented, necessitating a comprehensive bibliometric analysis to identify key trends, influential contributors, and critical research areas. PurposeThis study explored current trends in nursing methods for DF care and their impact on patient outcomes, utilizing CiteSpace, VOSviewer, and Bibliometrix to identify key contributors, influential countries, and noteworthy topics, aiming to provide valuable insights for healthcare professionals and researchers in the field. MethodsRelevant publications from the Web of Science (WOS) Core Collection Science Citation Index Expanded were retrieved for the period between 2003 and 2023. We included peer-reviewed original articles or reviews related to diabetic foot (DF) and nursing. The following criteria were used for exclusion: ① conference abstracts or corrigendum documents, ② unpublished articles, ③ repeated publications, ④ unrelated articles, ⑤ case reports, and ⑥ qualitative studies. CiteSpace was employed to identify top authors, institutions, countries, keywords, co-cited authors, journals, references, and research trends. VOSviewer was used to generate a network of authors, journals, and references. Bibliometrix was utilized to create maps of cooperating countries and keyword frequency charts, as well as a Sankey diagram illustrating the relationship between authors, keywords, and countries. ResultsA total of 305 relevant articles were included in this study. The research pertaining to nursing aspects of diabetic foot care exhibited a noticeable upward trend. The analysis in this study revealed that “amputation" held the highest centrality, indicating a critical area of focus in nursing interventions to prevent severe outcomes. “Diabetic foot ulcer" ranked first in terms of citation rate, emphasizing the ongoing challenges in managing DFUs through nursing care. In recent years, there was a shift in focus towards keywords such as “pressure ulcers", “burden", and “chronic wound" highlighting the evolving priorities in nursing research to address complex wound care, patient burden, and long-term management strategies. ConclusionsThe current primary research focuses in nursing care for diabetic foot (DF) include wound management, offloading techniques, sensory protection, anti-infective treatment, education and self-management, and multidisciplinary teamwork. Future research should prioritize developing innovative nursing interventions tailored to individual patient needs, integrating advanced technologies like telemedicine and wearable devices for continuous monitoring, and exploring the psychological aspects of DFU management to improve patient adherence and outcomes. Additionally, more longitudinal studies are needed to assess the long-term effectiveness of various nursing strategies on patient quality of life.

Exploring health professionals' knowledge, practices and attitudes regarding gestational diabetes: A cross-sectional Irish national survey.

Gestational diabetes confers short- and long-term risk of mother and offspring health complications. Healthcare professionals such as endocrinologists, diabetes nurses, dietitians, midwives and general practitioners provide gestational diabetes care. We sought to explore healthcare professionals' perspectives on gestational diabetes care during pregnancy and postpartum. Healthcare professionals in the Republic of Ireland, whose role included gestational diabetes care were invited to complete an online 20-item survey between June and September 2022. Social media, professional organisations and personal networks were used for recruitment. Questions included guideline use, postpartum diabetes screening and advice practices. Analyses were performed using SPSS statistical software and free text was coded using NVivo. Seventeen healthcare professions across primary and secondary care settings participated (n = 127). No differences were noted between groups (medical, nursing/midwifery, allied health/other); therefore, findings were reported as a single group. Healthcare professionals reported using multiple different guidelines to support gestational diabetes management (n = 14). The most cited were 'Health Service Executive guidelines' (24.5%), 'local guidelines' (13.2%) and National Institute for Clinical Excellence guidelines (11.3%); 12.3% cited uncertainty, and 27.5% reported not to follow any named guidelines. For postpartum follow-up, 39% felt clear guidelines were available to support practice, 37% felt appropriate systems were in place and 29% reported effective communication between primary and secondary care services. Qualitative findings emphasised a desire for improved communication between systems, participants and providers, clear interdisciplinary guidelines, and adequate resourcing for gestational diabetes management and postpartum diabetes prevention, including comprehensive support and follow-up. System-level challenges and ineffective communication across settings are barriers to optimum postpartum care. Nationally agreed guidelines for best practice gestational diabetes management including postpartum diabetes prevention are needed.

Tailored care by diabetes nurses is not enough to overcome disparities in the regulation of type 2 diabetes between Dutch natives and ethnic minority groups

Background: Differences in diabetes regulation between patients from different ethnic background have been described. This may be reduced by regular visits to a diabetes nurse (RVDN) with the same mother tongue. We explored whether equal access to diabetes-related care, including RVDN with the same mother tongue, may result in similar diabetes regulation among ethnic minorities and Dutch natives. Methods: Patients with type 2 diabetes and an annual comprehensive diabetes evaluation were included in this study. For the analysis, we emphasized on the data of patients with RVDN and used descriptive statistics and nonparametric tests for between group comparisons. Results: From a total of 983 patients, 581 patients had RVDN of whom 266 (46%) Dutch natives, 199 (34%) Turks/Moroccans, and 116 (20%) patients from other ethnicities. Within the group of patients with RVDN, Turks/Moroccans had higher median fasting plasma glucose levels as compared with Dutch natives and other ethnic minorities (8.4 vs 7.9 and 7.3 mmol/L, P &lt; 0.001), and a higher HbA1c level was found for both the Turks/Moroccans and other ethnic minorities, as compared to Dutch natives (62 vs 55 mmol/mol, P &lt; 0.001). In addition, only 22% of Turks/Moroccans and 26% of other minorities achieved the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD)-recommended HbA1c target ≤53 mmol/mol, compared to 39% in Dutch natives. Conclusions: In patients with RVDN with the same mother tongue, we still found disparities in HbA1c levels between Dutch natives, Turks/Moroccans and other ethnic minorities. Other factors beyond Dutch language skills are likely to interfere.

COVID-19 Sürecinde Diyabet Hemşirelerinde Empatik Eğilim Düzeyinin Hasta Merkezli Bakıma ve Diyabet Hastalarında Glisemik Düzeye Etkisinin İncelenmesi

Amaç: Bu çalışmada COVID-19 sürecinde diyabet hemşirelerinde empatik eğilim düzeyi, hasta merkezli bakım ve diyabet hastalarının glisemik düzeyi arasındaki ilişkiyi incelemek amaçlandı.&#x0D; Yöntem: Bu araştırma, kesitsel ve tanımlayıcı tipte yapıldı. Araştırma, 01.06.2021-30.12.2021 tarihleri arasında COVID-19 pandemi süreci nedeniyle online anket oluşturularak (google.docs uygulaması) sosyal medya platformunda (Whatsapp) yürütüldü. Çalışmanın örneklemini 92 diyabet hemşiresi ve 920 diyabet hastası oluşturdu. Veriler; hemşire ve hastalar için Kişisel Tanıtım Formu, Hemşireler İçin Jefferson Empati Ölçeği (HÖİJEÖ) ve Hasta Merkezli BakımYetkinliği (HMBY) Ölçeği kullanılarak toplandı. Veriler, bilgisayarda SPSS 20.0 programı kullanılarak değerlendirildi. Çalışmada veri özelliğine göre Mann-Whitney U testi, bağımsız gruplarda Student t testi ve Pearson Korelasyon analizi uygulandı.&#x0D; Bulgular: COVID-19 sürecinde diyabet hemşirelerinin empatik eğilim düzeyleri ve HMBY puanının yüksek olduğu belirlendi. Diyabet hemşirelerinin empatik eğilim düzeyi ile diyabet hastalarının A1c düzeyi arasında anlamlı bir ilişki belirlenmedi (p&gt;.05). Lisansüstü eğitime sahip diyabet hemşirelerinin, lisans mezunu hemşirelere göre empatik eğilim düzeyinin istatistiksel olarak daha yüksek olduğu bulundu (p

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

Optimising &amp;amp; Integrated Effective Diabetic Foot Services at the Regional Scale: The NHS Midlands Model

Introduction: Diabetic foot disease represents a costly and challenging complication for healthcare services internationally, and one the diabetes complications associated with the highest degree of morbidity and mortality. It is estimated that between five and seven cent of people with diabetes will have a diabetic foot ulcer at some point in their lives, at an estimated cost of £935 million to the NHS. It is well recognised that effective diabetic foot care requires multidisciplinary care approaches. Whilst pockets of locally effective integrated care have been proven, scaling this to regional models has proved difficult. Here we present an effective optimised approach to integrated diabetic foot care in the Midlands Region as a model for other services internationally.&#x0D; Methods: Four pillars are underpin effective change at a regional level in the United Kingdom covering 5.4 million people. These pillars are (1) Utilisation of standardised audit data as a driver for change, (2) Regional self appraisal and peer review (3) Cross-boundary integrated root cause analysis and (4) adoption, piloting and testing of new digital technologies. We present an example of “guerrilla PPI” to facilitate real-time representative patient and public involvement. Central to the success was an infographic base communication and dissemination strategy with a focus on prevention.&#x0D; Results: Successful creation of a 300 person multidisciplinary foot care network including podiatrists, consultants, diabetes nurses, commissioners, community representatives, transformation leads, Diabetes UK, patient representatives and nurse specialists. Peer review, root cause analysis and audit presentation data across the whole of the Midlands region covering all diabetes providers. High impact bespoke infographics presented for all sub-regions to further drive change. Major 6 month amputation rates from reduced from 2.9% in 2014/2015 to 2.1% in 2020/2021 and reduction in audit active ulcer rates from 47.1% to 42.4%despite the pandemic environment.&#x0D; Conclusions: Effective integrated diabetic foot care can be delivered at the regionally scale for large populations if underpinned by a defined network with shared vision, transparent structures and shared Trust. Cross-organisation working is fundamental but can be enabled through standardised peer review, audit, root cause analysis and self-appraisal models.

Making prediabetes visible in primary health care: a qualitative study of health care professionals’ perspectives

BackgroundPeople with prediabetes are at high risk of developing type 2 diabetes and its complications, such as cardiovascular diseases and premature mortality. Primary prevention and health maintenance are therefore imperative. Evidence has shown that prediabetes can be prevented or delayed with behavioural change, mainly in eating habits and physical activity. Interventions that use a person-centered approach can lead to improvements in self-management, quality of life, and health outcomes. Nevertheless, there is a need for further research that engages healthcare professionals and people with prediabetes in constructing and implementing preventive programs. The purpose of this study is to explore and describe how healthcare professionals perceive prediabetes, the current challenges in its detection and treatment, and what is needed to improve quality of care.MethodsThis qualitative study was conducted in Region Stockholm. A total of 26 primary health care professionals participated in individual interviews: 15 diabetes nurses and/or district nurses, five general practitioners, five dietitians, and one physiotherapist. Interview transcripts were analyzed with qualitative content analysis.ResultsThe analysis revealed two main themes that emphasize the need to make prediabetes more visible in primary health care. Despite the healthcare professionals’ engagement and their motivation to improve prediabetes care, ad hoc practices and the absence of clear screening guidelines and referral pathways made it harder to focus on primary prevention. Supporting professionals in implementing structured care for people with prediabetes might encourage more efficient interprofessional collaboration and contribute to better strategies for promoting behavioural change.ConclusionsEstablishing prediabetes care guidelines, supporting health care professionals´ knowledge and skills in prediabetes care, and implementing interprofessional referral pathways are some steps to enhance prediabetes detection and care precedence in primary health care. These steps could lead to more preventive care and ensure patient safety and health care equity.

Nursing care for diabetes mellitus

Background. Due to the global rise in diabetes patients, nurses of all specialties and positions are increasingly caring for these individuals on a daily basis. The purpose of this study was to examine the latest re­commendations and individual studies on diabetes management and to determine the place of nurses in a multidisciplinary team. Materials and methods. The article used descriptive methods and methods of comparative analysis to determine the characteristics of nursing practice in the management of patients with diabetes. Results. From the information studied, it became clear that nurses should be prepared to receive quality education associated with ongoing support and care in the community, primary health care institutions or in hospitals for such patients. Education in self-management and psychosocial problem solving are key elements of diabetes care and nursing. The Diabetes Self-Management Education and Support program is a crucial tool for patient-nurse communication, involving ongoing psychological support through educational techniques to address questions and concerns from individuals with diabetes and their families. Conclusions. Trained nurses can also perform screening for mental disorders and diabetes complications in order to timely diagnose or prevent their development. Regardless of new technologies or treatments, nurses must never lose their role as advocates for patients’ rights.

Supporting women with diabetes before, during and after pregnancy.

Nuru Clark, Diabetes Specialist Nurse, Barts Health NHS Trust, London (nuru.clark@nhs.net), was the Gold Award winner in the Diabetes Nurse of the Year category of the BJN Awards 2023.

A Nationwide Cross-sectional Survey of Knowledge and Practices of Diabetes Drug Injection Techniques of Patients, Nurses, and Physicians: The China IT Improve Study

ObjectiveTo investigate the knowledge and practices of diabetes drug injection techniques of diabetes patients, nurses, and physicians to support formulating national guidelines for standardized diabetes drug injection techniques. Patients and MethodsIn this nationwide multicenter cross-sectional survey conducted between November and December 2020, patients, nurses, and physicians were randomly chosen from 250 primary, 150 secondary, and 100 tertiary care hospitals using the stratified cluster sampling method. Their knowledge and/or practices of diabetes drug injection techniques were surveyed using the Diabetes Drug Injection Knowledge and Practice Questionnaire for Physicians, Nurses, and Patients. ResultsIn total, 10,694, 2643, and 2816 eligible questionnaires were collected from patients, physicians, and nurses, respectively. Overall, 78.2% (7588/9709) type 2 diabetes patients failed to attain the target hemoglobin A1c. Hypoglycemic episodes and lipohypertrophy occurred in 19.8% and 34.7% of the patients, respectively. Needle reuse (odds ratio, 1.19; 95% CI, 1.07 to 1.33) and incorrect injection site rotation (odds ratio, 1.32; 95% CI, 1.16 to 1.51) were associated with failure to attain the target hemoglobin A1c. Overall, 48.9% physicians and 20.4% nurses had a poor knowledge domain score. Care setting and training, diabetes care experience, and regions were significant determinants of diabetes drug injection knowledge domain scores in both physicians and nurses. ConclusionPoor glycemic control, occurrences of injection-associated complications in diabetes patients, and poor knowledge domain scores of a subset of physicians and nurses highlight the importance of regular assessment and education regarding diabetes drug injection techniques for physicians and nurses and development of national guidelines for diabetes drug injection. Trial RegistrationChictr.org.cn (ChiCTR2100045302).

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.

Patient, family member, and health care provider perspective on barriers and facilitators to diabetic retinopathy screening in Thailand: A qualitative study.

Diabetic retinopathy (DR) can cause significant visual impairment which can be largely avoided by early detection through proper screening and treatment. People with DR face a number of challenges from early detection to treatment. The aim of this study was to investigate factors that influence DR screening in Thailand and to identify barriers to follow-up compliance from patient, family member, and health care provider (HCP) perspectives. A total of 15 focus group discussions (FGDs) were held, each with five to twelve participants. There were three distinct stakeholders: diabetic patients (n = 47) presenting to a diabetic retinopathy clinic in Thailand, their family members (n = 41), and health care providers (n = 34). All focus group conversations were transcribed verbatim. Thematic analysis was used to examine textual material. Different themes emerged from the FGD on knowledge about diabetes, self-care behaviors of diabetes mellitus (DM), awareness about DR, barriers to DR screening, and the suggested solutions to address those barriers. Data showed lower knowledge and awareness about diabetes and DR in both patients and family members. Long waiting times, financial issues, and lack of a person to accompany appointments were identified as the major deterrents for attending DR screening. Family support for patients was found to vary widely, with some patients reporting to have received adequate support while others reported having received minimal support. Even though insurance covered the cost of attending diabetes/DR screening program, some patients did not show up for their appointments. Patients need to be well-informed about the asymptomatic nature of diabetes and DR. Communication at the patient level and shared decision-making with HCPs are essential. Family members and non-physician clinicians (such as diabetes nurses, diabetes educators, physician assistants) who work in the field of diabetes play a vital role in encouraging patients to attend diabetes and DR follow-ups visits regularly.

Midwives' and Diabetes Nurses' Experience of Screening and Care of Women with Gestational Diabetes Mellitus: A Qualitative Interview Study.

Gestational diabetes mellitus (GDM) is increasing and is associated with adverse outcomes for both mother and child. The metabolic demands of pregnancy can reveal a predisposition for type 2 diabetes mellitus (T2DM), and women with a history of GDM are more likely to develop T2DM than women with normoglycemic pregnancies. The aim of this study was to explore midwives' and diabetes nurses' experience of their role in screening, care, and follow-up of women with gestational diabetes mellitus and, further, to explore their opinions and thoughts about existing routines and guidelines. Individual interviews were performed with ten diabetes nurses and eight midwives working in primary and special care. Qualitative content analysis was done according to Graneheim and Lundman. The analysis of the interviews resulted in the overall theme "An act of balance between normalcy and illness, working for motivation with dilemmas throughout the chain of health care." Difficulties in carrying out the important task of handling GDM while at the same time keeping the pregnancy in focus were central. Women were described as highly motivated to maintain a healthy lifestyle during pregnancy with the baby in mind, but it seemed difficult to maintain this after delivery, and compliance with long-term follow-up with the aim of reducing the risk of T2DM was low. The women came to the first follow-up but did not continue with later contact. This was at a time when the women felt healthy and were focusing on the baby and not themselves. A lack of cooperation and easy access to a dietician and physiotherapist were pointed out as well as a wish for resources such as group activities and multiprofessional teams.

1831-PUB: Improving Accessibility of Patients with Type 1 Diabetes to Treatment by a Diabetes Nurse Practitioner

Background: Treatment of type 1 diabetes (T1D) is complex, requires therapeutic intensity and understanding patient needs. The COVID-19 pandemic has led to a rapid and dramatic increase in the use of telemedicine to maintain treatment continuum and response to patients. Dedicated software, developed to transfer data from patients’ glucose sensors and insulin pumps to the treating team, facilitates personalized therapeutic interventions. Diabetes Nurse Practitioners (DNPs) have the knowledge, treatment skills and expertise for analyzing patient data transferred by the software; hence, they are an essential resource for managing diabetes treatment in these patients. The lack of suitable infrastructure and staff members who specialize in T1D has led to the establishment of a dedicated DNP unit within a diabetes clinic in Israel. The unit’s services are provided by frontal and telemedicine sessions to patients aged 18-40 with T1D. Its aims include continuous and regular monitoring of patients, achieving glycemic control according to patients’ personal targets, and preventing acute and late complications. The DNP provides comprehensive advice and training, assesses, and evaluates the patients' conditions, adjusts their therapy and refers them to appropriate care providers based on their medical and emotional conditions. Each session lasts 30-45 minutes. The summary of each session is sent to the diabetes doctor and to the primary clinic’s team. Methods: Analysis of patient data treated by the dedicated DPN unit between January and July 2022. Results: A total of 143 patients underwent 537 sessions; 55% were frontal visits and 44.4% were telemedicine visits (online or by phone). improved glycosylated hemoglobin was noted in 61% of patients. One patient was hospitalized. Conclusions: DNPs are an important factor for improving the quality of care of patients with T1D by providing personalized care, continuous contact and better access to services through remote consultation. Disclosure O.Waizinger: None.

A QUALITATIVE STUDY ON THE IMPROVEMENT OF DISEASE MANAGEMENT POLICIES IN DIABETES IN TURKEY

This study, it was aimed to determine the need for disease management in diabetes in Turkey and to reveal the recommendations for diabetes disease management policies as part of the identified needs. In this study, the research design was planned as a case study and, the snowball sampling method was used as part of the scope of qualitative research. A total of 21 individuals, 6 doctors, 3 diabetic nurses, 6 academics, and 6 adult diabetics were actualized using semi-structured forms with a thorough interview technique. The data collected were evaluated with descriptive analysis and content analysis methods. In the analysis of the data, the “Nvivo 12. Program” was used. The findings were discussed based on the relevant literature, and conclusions and recommendations were reached in line with the research purposes. The participants stated that the practices related to disease management in diabetes have improved compared to the past, but that the development process should continue. The participants stated that there is a need for a multidisciplinary systematic process structuring that will prioritize the patient and their needs and that will help patients to live their lives healthy and free from complications. In terms of the burden of disease, diabetes is a significant issue that affects both Turkey and the rest of the world. We propose that the health policy, health service delivery, health system structure, and multidisciplinary work related to the disease management approach in diabetes in Turkey should be determined and steps should be taken to improve it.

Experiences of Patients With Type 2 Diabetes Who Recovered From COVID-19 in the Pandemic Period: A Qualitative Study.

Coronavirus disease 2019 (COVID-19) infection can induce acute and chronic complications by affecting the self-management behaviors of individuals with diabetes. The objective of this study is to examine the physical, psychosocial health, and self-management experiences of type 2 diabetes patients who have recovered from COVID-19, 1 year after the infection. The study adopted a qualitative research design, specifically content analysis. In all, 14 patients with type 2 diabetes who presented to the diabetes outpatient clinic were interviewed by teleconferencing, which lasted approximately 25 to 30 minutes. The Standards for Reporting Qualitative Research guidelines were used. Based on the participants' responses, four main themes were determined: obstacles in activities of daily living, feeling of psychosocial problems, changes in health and treatment management, and patient self-management practices. Amid the pandemic, diabetes nurses should strive to recognize the issues that diabetes patients encounter. To assist patients, telemedicine should be leveraged, and evidence-based practices must be developed.