Diabetes Nurses Research Articles

Diabetes nursing: supported by research and supporting research

(2009). Diabetes nursing: supported by research and supporting research. European Diabetes Nursing: Vol. 6, No. 2, pp. 49-49.

Diabetes self-care maintenance, comorbid conditions and perceived health

Background: The rising global prevalence of diabetes mellitus (DM) has made it increasingly important for healthcare providers to examine how amenable factors beyond optimal medical care might influence health outcomes. DM self-care maintenance (SCM) is an important influential component of overall care, and perceived health is an important subjective health outcome. However, the relationship between DM SCM and perceived health has not been examined extensively. Aim: To study the relationship between DM SCM and perceived health. Methods: A secondary analysis was performed using cross-sectional descriptive self-reported data from 1154 adults with DM living in Pennsylvania. Multivariate hierarchical logistic regression modelling was used to determine whether better SCM was significantly associated with better perceived health, controlling for the influence of sociodemographics and comorbid conditions. Results: Higher levels of engagement in SCM (healthier diet and more exercise) were significantly associated with better perceived health. Three comorbid conditions included in the model were associated with worse perceived health. Conclusion: Our data suggest that interventions designed to improve outcomes for patients with DM should take into account the relationship between SCM and perceived health. Although further research is needed to replicate our findings in more heterogeneous patient populations, nurses should consider improving SCM as a means of improving health outcomes, such as health status in patients with DM. Eur Diabetes Nursing 2009; 6(2): 65‐68

Perinatal risk factors in young adult‐onset type 1 and type 2 diabetes – a population‐based case‐control study

To examine the effects of the size of the mother and the newborn, including placental weight and gestational age at delivery, on the risk for young adult-onset type 1 diabetes (T1DM) and type 2 diabetes (T2DM). Case-control study. Finland. Subjects with T1DM and T2DM aged 15-39 at diagnosis between the years 1992 and 1996. The number of case-control pairs was 858 for T1DM and 355 for T2DM. Diabetic subjects were identified from the Finnish national healthcare registers and reports from diabetes nurses. Control subjects were obtained from the population register. Data on perinatal factors were obtained from the original healthcare records. The odds ratios (ORs) for both types of diabetes were estimated using conditional logistic regression. The risk for early-onset T2DM decreased with increasing birthweight until 4.2 kg (OR 0.49 (95% confidence interval 0.37-0.66) per 1 kg), but with birthweight above 4.2 kg the risk increased (OR 4.8 (1.3-17.6) per 1 kg). The risk for T2DM decreased also with increasing birth length (OR 0.88 (0.81-0.95) per 1 cm), body mass index at birth (OR 0.81 (0.73-0.90) per 1 kg/m2), and placental weight (OR 0.77 (0.61-0.98) per 100 g). The latter was not significant when adjusted for birthweight. The examined perinatal factors did not affect the risk for T1DM in young adults. Birth size significantly affects the risk for T2DM diagnosed in young adulthood but no evidence was found of an association between late-onset T1DM and perinatal factors.

Diabetes nursing

Diabetes nursing

Autonomous Decision Making and Moral capacities

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

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

Conferences & Meetings

The Diabetes Nurse Prescriber Network has been set up by Reading University. The Network aims to support health care professionals, who prescribe in the area of diabetes, in their continuing professional development by providing a forum for peer support, the exchange of ideas and information, and the sharing of good practice. The Network holds three meetings a year (free to members) and members receive a quarterly hardcopy newsletter containing news and information about diabetes prescribing. The cost to join the Network is £20.

A meeting report from the Federation of European Nurses in Diabetes (FEND)

(2008). A meeting report from the Federation of European Nurses in Diabetes (FEND) European Diabetes Nursing: Vol. 5, No. 3, pp. 116-119.

Proposal for an EU directive on patients' rights in cross-border healthcare

"Proposal for an EU directive on patients' rights in cross-border healthcare." European Diabetes Nursing, 5(3), p. 88

Use of complementary and alternative medicine in children with type 1 diabetes

"Use of complementary and alternative medicine in children with type 1 diabetes." European Diabetes Nursing, 5(3), p. 98

Barriers to Hyperglycemia Control in Hospitalized Patients: a Descriptive Epidemiologic Study

To identify barriers that prevent appropriate control of hyperglycemia in a university teaching hospital and to document their frequency in patients hospitalized for cardiothoracic surgery. In this observational study, our inpatient diabetes team identified barriers to adequate glycemic control for diabetic patients in the cardiothoracic surgical intensive care unit between September 1, 2006, and January 3, 2007. Data were collected through chart review and patient and staff interviews. Blood glucose concentrations greater than 160 mg/dL prompted intervention, which involved speaking to the prescribing practitioner and making a treatment recommendation. Each intervention was reviewed by the diabetes nurses using the critical incident technique. The nurses determined which underlying barriers were responsible for the lack of glycemic control and had necessitated the intervention. Of 105 patients, 6 (5.7%) demonstrated good glucose control (75% of their blood glucose measurements were 80-160 mg/dL) and did not require intervention, and 99 (94.3%) required intervention. Diabetes nurses intervened 202 times; each patient averaged 2.04 interventions during their hospital stay. Nurses coded 398 barriers to the 202 interventions; each intervention had between 1 and 5 barriers coded as the underlying reason(s) for the intervention. Thirty barriers to adequate glycemic control were identified. Eight barriers represented 74% of the barriers encountered. Therapeutic reluctance was the most common followed by inappropriate titration of medication, lack of basal insulin, lack of weekend staff trained in diabetes management, use of a sliding scale, inappropriate medications being prescribed, knowledge deficit of the weekend staff, and outpatient diabetes medications not being restarted. We identified the most frequent barriers to adequate glycemic control in this group of patients and suggest how limited resources should be focused to improve glycemic control. Barrier incidence should be determined in other populations of diabetic patients.

The diabetes image: personal, professional, political, societal

The diabetes image: personal, professional, political, societal

The work setting of diabetes nursing specialists in the Netherlands: A questionnaire survey

Aim The aim of this study is to explore whether the work organisation of diabetes specialist nurses (DSNs) differs significantly from nurses working in hospital and nursing home and if so, does this difference result in positive or negative consequences regarding work and health. Background In traditional health care settings, nurses exhibit a high level of environmental uncertainty and low decision-making authority, which has a negative effect on psychological reactions towards work. In professional nursing, specialisation, e.g. diabetic nursing, is a current trend in many countries. Therefore, insight into the determinants of the work situation of nursing specialists is becoming increasingly relevant. Methods Comparisons were made between 3 different samples: 1204 nurses employed by 15 hospitals, 1058 nurses employed by 14 nursing homes, and 350 diabetes nurses working in other health care settings throughout the Netherlands. Data concerning organisation, work aspects, and psychological reactions were measured via questionnaires. Variances between the groups were analysed with ANCOVA, besides hierarchical multiple regression analysis was applied. Findings Environmental uncertainty scored lower amongst diabetes nurses when compared to nurses working in the other two types of health care settings. Social support and role conflict scored low for diabetes nursing specialists who simultaneously perceived autonomy and role ambiguity highest. Diabetes nursing specialists also scored highest on intrinsic work motivation and job satisfaction and lowest for psychosomatic health. Conclusion Except for social support and role ambiguity, diabetic nurses rate their [work] organisation, [work] aspects and psychological [work] reactions more positively than nurses employed in other health care settings.

The lived experience of the diabetes nurse specialist regular check‐ups, as narrated by patients with type 2 diabetes

The aim was to elucidate the lived experience of regular diabetes nurse specialist check-ups among patients with type 2 diabetes. Diabetes care with diabetes nurse-led clinics in primary care has been established in Sweden since the 1980s. Information about patients' lived experience of these regular check-ups is important in the further development of diabetes nursing in primary care. Narrative interviews were conducted with 10 women and 10 men with type 2 diabetes regarding their lived experience in everyday life and the regular check-ups by the diabetes nurse specialist. A phenomenological-hermeneutic method inspired by Ricoeur was used in the analysis. Patients'- with type 2 diabetes - lived experience of regular check-ups showed an overall positive influence on the patients' way of living with the disease by underpinning and developing their understanding and management of daily life. This influence was interpreted as an interlinked chain comprising the following elements; being confirmed, being guided within the disease process, becoming confident and independent and being relieved. Every link contained a positive influence from being dependent-independent, autonomous and a feeling of freedom in patients striving for an everyday life with a disease under control. The development of diabetes-nurse-led clinics from the perspective of the patient must consider the patient's individual need for support and continuity with the diabetes nurse specialist. Consultations with collaborative partnership and specific expertise that is easy to access implied autonomous disease self-management in terms of patients' own control of the disease over time. In view of the increasing number of patients with diabetes, this could positively impact the availability of diabetes nursing care.

Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002

To establish the gender difference amongst newly diagnosed type 1 diabetic patients aged 15-34 years, considering age at diagnosis, temporal trend and seasonal variation at time of diagnosis. A population-based prospective study with a mean annual population at risk of 2.3 million. All departments of medicine, endocrinology and paediatrics and primary health care units in Sweden. Incident cases of diabetes aged 15-34 years at diagnosis 1983-2002. MEASURE INSTRUMENT: Basic characteristics of patients at diagnosis were reported by the diagnosing doctor on a standardized form. Level of ascertainment was estimated at 80-90%. Amongst all incident cases (n = 8012), 74% was diagnosed with type 1 diabetes. The mean annual incidence rate of type 1 diabetes was 12.7/100,000, in men 16.4/100,000 and in women 8.9/100,000. The incidence of type 1 diabetes decreased slowly by increasing age but was in all age groups higher in men, yielding an overall male/female ratio of 1.8. In both genders the incidence of type 1 diabetes decreased in average of 1.0% per year. A seasonal pattern with significantly higher incidence during January-March and lower during May-July was seen in both genders. A clear male predominance of type 1 diabetes was seen in all ages. The temporal trend and the seasonal pattern was similar in men and women. Hence, internal factors related to the gender rather than differences in the exposure to environmental factors seem to explain the consistent male-female bias in the postpubertal risk of developing type 1 diabetes.

Developing an integrated career and competency framework for diabetes nursing

To describe the development of an integrated career and competency framework for diabetes nursing. The UK Nursing and Midwifery Council provides a definition of competence, but the terminology used in relation to the subject is often ambiguous and confusing. These concepts are explored in relation to nursing practice and the different approaches to competency framework development are described. To work alongside the Royal College of Nursing (RCN) and Skills for Health competency initiatives, a Diabetes Nursing Strategy Group representing nurses working in diabetes care was formed to oversee the development of an integrated career and competency framework for diabetes nursing. At the outset, the design was guided by the RCN Practice Development Team and employed qualitative methodology including the modified Delphi and nominal group technique. A purposive sample of nurses representing all sectors and grades of staff involved in diabetes care was invited to workshops to undertake a values clarification exercise. Content analysis was performed to identify themes. Further workshops identified areas of specialist practice and competence statements were developed and refined in a series of consultations. Competence statements for a range of diabetes-related areas were produced for nurses at the levels of unregistered practitioners, competent nurses, experience/proficient nurses, senior practitioners/expert nurses and consultant nurses. The description of the process of developing of the integrated career and competency framework should help other groups going through the same process. Relevance to clinical practice. In addition to helping groups identify a formula for the development of a competency framework, the framework itself is designed to provide a basis for educational programmes, personal career development and a tool for managers managing career progression within diabetes nursing.

The effect of birth order and parental age on the risk of type 1 and 2 diabetes among young adults

The aim of this study was to examine the effects of birth order and parental age on the risk of type 1 and type 2 diabetes among Finnish individuals aged 15-39 years. Data on all cases of type 1 diabetes (n = 1,345) and type 2 diabetes (n = 1,072), diagnosed between 1992 and 1996, were collected from four sources: standardised national reports from diabetes nurses, the National Hospital Discharge Register, the Drug Prescription Register and the Drug Reimbursement Register. Information on matched controls and the family members of all study subjects were obtained from the National Population Registry. The odds ratios (ORs) for both types of diabetes were estimated using a conditional logistic regression model. There was a U-shaped relationship between maternal age and the risk of type 2 diabetes in the offspring: the risk was higher in children born to young and old mothers compared with children born to mothers aged around 30 years. The children born second (OR 0.76, 95% CI 0.62-0.94), third (OR 0.73, 95% CI 0.55-0.95), or fourth (OR 0.66, 95% CI 0.47-0.94) had a lower risk of type 2 diabetes than the first-born children. Maternal age, paternal age, and birth order did not have an effect on the risk of type 1 diabetes in the individuals aged 15-39 years at the time of diagnosis. Maternal age and birth order are both associated with the risk of early-onset type 2 diabetes. However, part of these associations may be due to low birthweight. In this study neither parental age nor birth order showed a significant association with the risk of type 1 diabetes diagnosed after 15 years of age.

Choice: How to achieve the balancing act in diabetes care

"Choice: How to achieve the balancing act in diabetes care." European Diabetes Nursing, 4(2), pp. 78–79

Systematic Review of Primary Healthcare Interventions to Improve Diabetes Outcomes in Minority Ethnic Groups

To systematically review the effectiveness of primary care interventions on glycaemic control and cardiovascular risk factors in minority ethnic groups with diabetes. We searched electronic databases, the Cochrane Library, and research registers to December 2006, using multiple search terms related to ethnicity and diabetes. We examined bibliographies of retrieved articles and corresponded with authors. We included randomized controlled trials, controlled clinical trials, and cohort studies. Two reviewers independently assessed study eligibility and quality. Nine studies including 2565 patients met our inclusion criteria. Two main models of care were identified: (1) case management, with specialist diabetes nurses and community health workers and (2) the use of the services of link workers from minority ethnic groups to guide people with diabetes. Heterogeneity of the studies prevented us from carrying out a meta-analysis. Case management improved glycaemic control (reduction in HbA1c range -0.5% to -1.75%). Small but statistically significant reductions in other cardiovascular risk factors were reported with both models. In minority ethnic groups with diabetes, case management improves glycaemic control and cardiovascular risk factors and link workers improve cardiovascular risk factor control. However, their relative effectiveness, cost, and sustainability of changes over time warrant further evaluation.

A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996

The aim of this study was to examine the incidence and trends of type 1 and type 2 diabetes in the 15-39 year-old population between 1992 and 1996 in Finland. Data on the nationwide incidence of diabetes were obtained from four data sources: standardised reports from diabetes nurses, the Finnish National Hospital Discharge Register, the Drug Reimbursement Register and the Drug Prescription Register. The inclusion criterion was consistency in the diagnosis of diabetes across at least two data sources. The sex- and age-specific incidence was calculated for 5-year age groups, both for type 1 and type 2 diabetes. The effects of age, sex and year of diagnosis were assessed by fitting the linear regression model to the incidence data. Between 1992 and 1996 the age-adjusted incidence of type 1 diabetes among 15-39 year olds was 15.9 per 100,000/year. The incidence was highest among the 15-19 year olds and decreased with age. Conversely, the incidence of type 2 diabetes was very low among 15-19 year olds and increased with age. The total age-adjusted incidence of type 2 diabetes among 15-39 year olds was 11.8 per 100,000/year. The average annual increase in the incidence of type 2 diabetes was 7.9% (95% CI 3.7-12.2%). The age at which the Finnish population is at risk of type 1 diabetes extends into young adulthood. The rapid increase in the incidence of type 2 diabetes in the young adult population is a current public health problem.