Diabetes Nurses Research Articles

Lower Versus Higher Glycemic Criteria for Diagnosis of Gestational Diabetes

ABSTRACT Gestational diabetes mellitus (GDM) in pregnancy is a global health problem. Maternal risks associated with this condition include higher rates of induced labor, cesarean delivery, and preeclampsia. Fetal exposure to GDM can increase the risk of large for gestational age (LGA), as well as operative birth, shoulder dystocia, and birth injuries. To reduce these risks, GDM is managed with nutritional therapy, blood glucose monitoring, and pharmacologic treatment. However, the criteria to diagnose GDM in pregnant individuals vary globally. Although the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommends using a lower glycemic threshold to diagnose maternal hyperglycemia, its adoption has been mixed. The aim of this study was to evaluate whether lower glycemic criteria to diagnosis GDM would improve perinatal and maternal outcomes. This was a randomized trial conducted in 2 health boards in New Zealand between April 2015 and August 2020. Included were women with singleton pregnancies who had a 75-g oral glucose tolerance test (OGTT) at 24 to 32 weeks of gestation. Excluded were those with diabetes mellitus or a history of GDM. The women were randomly assigned to be evaluated for GDM using lower glycemic criteria for diagnosis or higher criteria in a 1:1 ratio. The lower criteria were defined as a fasting plasma glucose level ≥5.1 mmol/L, a 1-hour level ≥10.1 mmol/L, or a 2-hour level ≥8.5 mmol/L. The higher criterion was a fasting plasma glucose level ≥5.5 mmol/L or a 2-hour level ≥9 mmol/L. The primary outcome was LGA. A total of 4050 women and their infants were randomized and included in the analysis—2019 in the lower criteria group and 2013 in the higher criteria group. There were 8.8% LGA infants born in the lower criteria group and 8.9% in the higher criteria group (unadjusted relative risk, 0.99; 95% confidence interval [CI], 0.81–1.21; P = 0.91). Infants in the lower criteria group were more likely to have hypoglycemia compared with those in the higher criteria group (10.7% vs 8.4%; adjusted relative risk [aRR], 1.27; 95% CI, 1.05–1.54). Women in the lower criteria group were more likely to undergo induced labor (33.7% vs 30.2%; aRR, 1.12; 95% CI, 1.02–1.22) or use pharmaceutical treatment for GDM (10.9% vs 4.6%; aRR, 2.40; 95% CI, 1.90–3.03). They also had more diabetes service visits (0.6 ± 1.6 vs 0.2 ± 1.0; aRR, 2.42; 95% CI, 1.80–3.26), as well as visits with diabetes medical specialists post-OGTT (0.3 ± 0.9 vs 0.1 ± 0.6; aRR, 2.39; 95% CI, 1.80–3.18), diabetes nurses (0.4 ± 1.2 vs 0.2 ± 0.8; aRR, 2.41; 95% CI, 1.80–3.21), and dietitians (0.1 ± 0.3 vs <0.1 ± 0.3; aRR, 2.26; 95% CI, 1.73–2.95). Among women in both groups whose OGTT results were between the lower and higher thresholds, 195 received GDM treatment, and 178 did not. Those in the lower criteria group had fewer LGA infants (6.2% vs 18.%; aRR, 0.33; 95% CI, 0.18–0.62) than those in the higher criteria group. They also experienced less gestational weight gain (10 vs 11.9 kg), had a lower incidence of preeclampsia (0.5% vs 5.6%), were more likely to have labor induced (56.9% vs 30.3%), and had a higher prevalence of breastfeeding when discharged from the hospital (99.5% vs 94.9%). In conclusion, pregnant women evaluated for GDM using lower glycemic criteria group were more than 2.5 times as likely as those in the higher criteria group to receive a diagnosis and treatment. However, despite increased identification and treatment of GDM, the lower glycemic criteria did not result in apparent perinatal or maternal benefit in the population being screened, but some potential benefit was identified in the subpopulation of those with the test values just below the higher threshold.

Diabetic Nurse Educator and the Emerging Technologies: Architects in Management of Children with T1DM

Diabetic Nurse Educator and the Emerging Technologies: Architects in Management of Children with T1DM

Investigation of the Cultural Competence Levels of Diabetes Nurses

Objective: It is important for nurses to have cultural competence in order to keep up with the cultural diversity brought by globalization. In this study, we aim to examine the cultural competence levels of diabetes nurses in diabetes education and care in accordance with the cultural characteristics of individuals with diabetes.
 Methods: This study was conducted in a cross-sectional descriptive type with 183 diabetes nurses between September 15 and December 15, 2020 in Turkey. The data were collected using the Introductory Information Form and the Nurse Cultural Competence Scale.
 Results: We determine that almost all of the diabetes nurses had cultural competence above the average. We find that having a postgraduate degree from diabetes nurses, receiving cultural education before, and having a diabetes nurse experience of 6 years or more affected the cultural competence levels (p

The Role Of The Diabetes Specialist Team In The Modern Management Of Diabetes Mellitus: A Call For Its Implementation In Ghana

Many chronic illnesses require patient-centred care where behavioural change aimed at dealing and coping with the socio-psychological as well as the physical impact of the disease is emphasized.
 Diabetes presents such a challenge especially in the developing world where both human and material resources are limited in dealing with this complex disease. Most centres in Ghana and Africa in general, rely on overburdened practitioners who have responsibilities to other acute and chronic illnesses in addition to diabetes care.
 The Diabetes Specialist Team (DST) has become a tool in overcoming these complexities to improve care and outcomes. They work in a team with specialised and sometimes overlapping skills. Core members include Consultant physician diabetologists, specialist diabetes nurses, podiatrists, dieticians and clinical psychologists.
 The positive impact of DST is noticed in the aspects of diabetes preventive services, early diagnosis, patient education, medication use, risk factor and complication identification and management, together with in-patient care and management of special groups.
 Recognising that the needs of persons living with diabetes are under served, coupled with the fact that developing countries are expected to experience the greatest burden in terms of numbers and complications of diabetes, more resources are needed to reverse these expected grim statistics. Efforts should be made to develop and deploy DST as much as possible to provide specialised and dedicated services in the routine management of diabetes at least at the district or municipal health level. Resources are needed to maintain and snowball the impact of this approach.

Examining the Nursing Impact of Diabetes Patients' Health Education and the Endocrinology Department's Diabetes Nursing Practice of Maternity and Children Hospital of King Khaled

Examining the Nursing Impact of Diabetes Patients' Health Education and the Endocrinology Department's Diabetes Nursing Practice of Maternity and Children Hospital of King Khaled

Supporting people with type 2 diabetes who need insulin

Abstract The year 2022 marks 100 years since the first person with diabetes received an insulin injection and supporting people with insulin self‐management is a core role for diabetes nurses. Janet Kinson was a diabetes nurse and author. She developed the first diabetes education programme for nurses and the topic of insulin was central to the curriculum. This article will honour the contribution she made by focusing on diabetes education for people with type 2 diabetes who need insulin. It will start by tracing why and when people with type 2 diabetes should start insulin treatment followed by an exploration of the barriers to starting insulin at the level of the individual, the health care professional and the health system. We know that around 50% of people with type 2 diabetes delay starting insulin for seven years when it is clinically indicated. We also know that around a third of people with type 2 diabetes who are insulin treated remain hyperglycaemic or experience frequent hypoglycaemia. Therefore, there is a need for interventions that address delay, optimise starting insulin as well as consider how we best support people with type 2 diabetes to persist with and intensify their insulin over the diabetes journey. This article presents the current literature on interventions to support people with type 2 diabetes with insulin and identify gaps in support that may be addressed in future research. Copyright © 2022 John Wiley & Sons..

Qualitative exploration of patient and healthcare professional perspectives on barriers and facilitators to foot self-care behaviors in diabetes

IntroductionDiabetic foot ulcers contribute significantly to morbidity and mortality associated with diabetes, but are preventable with good foot self-care. This study sought to explore the perspectives of patients and healthcare...

Prediabetes screening, treatment, and follow‐up in primary health care: a cross‐sectional survey

Abstract Aim: This study aimed to describe routines for screening, treatment, and follow‐up for prediabetes at primary health care centres in Region Stockholm, Sweden.Methods: The study had a cross‐sectional design. We sent a questionnaire about prediabetes screening, treatment, and follow‐up to diabetes nurses working at primary health care centres in Region Stockholm. Data collection started in October 2019 and ended in June 2021.Results: A total of 84 of the 224 centres that received an invitation responded (37.5%). Routines for screening, treatment, and follow‐up varied widely. This variation meant that people with prediabetes received different care, and the care depended on clinical practice routines at the primary health care centre they attended.Conclusions: A first step toward more consistent, adequate and equitable care should involve developing national and regional guidelines that include a clear and systematic approach to prediabetes screening, treatment and follow‐up. Sufficient funding and human resources will be crucial to implementing these guidelines in primary care to help prevent type 2 diabetes and its complications. Copyright © 2022 John Wiley & Sons.

Leeno: Type 1 diabetes management training environment using smart algorithms.

A growing number of Type-1 Diabetes (T1D) patients globally use insulin pump technologies to monitor and manage their glucose levels. Although recent advances in closed-loop systems promise automated pump control in the near future, most patients worldwide still use open-loop continuous subcutaneous insulin infusion (CSII) devices which require close monitoring and continuous regulation. Apart from specialized diabetes units, hospital physicians and nurses generally lack necessary training to support the growing number of patients on insulin pumps. Most hospital staff and providers worldwide have never seen or operated an insulin pump device. T1D patients at nurseries, schools, in hospital emergency rooms, surgery theatres, and in-patient units all require close monitoring and active management. The lack of knowledge and necessary training to support T1D patients on pumps puts them at life-threatening risks. In this work, we develop a training simulation software for hospitals to educate and train their physicians and nurses on how to effectively operate a T1D pump and reduce hypoglycemia events. The software includes clinically validated T1D virtual patients that users can monitor and adjust their pump settings to improve glycemic outcomes. We develop a Fuzzy-Logic learning algorithm that helps guide users learn how to improve pump parameters for these patients. We recruited and trained 13 nurses on the software and report their improvement in pump administration, basal rates adjustments, and ICR modulation.

Diabetes Education in Children and Adolescents with Type 1 Diabetes in China.

The prevalence of Type 1 Diabetes is increasing in pediatrics and diabetes education plays one of the most important role in the management of diabetes, especially in children. However, the related evidence concerned diabetes education is rare in children and adolescents. Therefore, we aimed to investigate the status of diabetes education in hospital, which could help us know the reality of diabetes education. We choose a nurse who is mainly responsible for diabetes education and management in each hospital to fill out the questionnaire. Overall, 98 nurses were enrolled from tertiary children's specialized hospitals and pediatric wards of general tertiary hospitals from Jan 2018 to Dec 2019. Of 98 nurses enrolled, 61 (63.3%) nurses from 98 hospitals responded, 39 (63.9%) of them received specialized training in diabetes. There were no differences in education characteristics among regions of China. There were 26(42.6%) hospitals have a full-time nurse for diabetes education or nurses with endocrinology training increased with the number of cases/year (P=0.02 and P=0.009). The use of game-based education, knowledge assessment at discharge did not vary among hospital volumes, and the presence of a psychiatrist (P=0.41, P=0.65, and P=0.85, respectively). Diet management education is the most common (23.0%) difficulty in children diabetes education. The level of diabetes education in children and adolescents varied among hospitals, but not among regions in China. There was a lack of resources provided for children and adolescents diabetes education in terms of training and specialized services.

Are guidelines a help or a hindrance?

The question of whether or not updated guidelines are a help or hindrance in clinical practice formed the focus of the June 2022 Trend Diabetes Nursing Conference held in London and Birmingham. Joy Ogden here reports on conference highlights examining this and other crucial considerations in the care of people with diabetes.

Nurses' role in diabetes management and prevention in community care.

Diabetes care-particularly in a community setting as a form of prevention and management, is a growing requirement across England and Ireland. Self-management skills are an essential part of diabetes management and nurses in the community setting are one of the first points of care to ensure this. It is therefore imperative that nurses working within these primary and community care settings have the knowledge and skills necessary to support those in the community setting to effectively manage their condition, improve their health outcomes and their quality of life. Primary care has been tasked with providing both routine and more complex diabetes care and highlights a risk of adverse outcomes if people with diabetes are transferred to general practices without adequate support. Developing an approach for effective and efficient joint collaboration for primary care and specialists to manage the population of people with diabetes under their care is vital in its prevention and management. So how can this be achieved and what resources are required? This article will discuss current research into clinical practice and pilots which can contribute to supporting a more holistic multi-disciplinary approach to diabetes management and prevention, and hence, a provision of community based services aimed at health prevention.

Non-adherence to guideline recommendations for insulins: a qualitative study amongst primary care practitioners

BackgroundGuideline adherence is generally high in Dutch general practices. However, the prescription of insulins to type 2 diabetes mellitus patients is often not in line with the guideline, which recommends NPH insulin as first choice and discourages newer insulins. This qualitative study aimed to identify the reasons why primary care healthcare professionals prescribe insulins that are not recommended in guidelines.MethodsDigital focus groups with primary care practitioners were organised. A topic list was developed, based on reasons for preferred insulins obtained from literature and a priori expert discussions. The discussions were video and audio-recorded, transcribed verbatim and coded with a combination of inductive and deductive codes. Codes were categorized into an existing knowledge, attitudes and behaviour model for guideline non-adherence.ResultsFour focus groups with eleven general practitioners, twelve practice nurses, six pharmacists, four diabetes nurses and two nurse practitioners were organised. The prescription of non-recommended insulins was largely driven by argumentation in the domain of attitudes. Lack of agreement with the guideline was the most prominent category. Most of those perspectives did not reflect disagreement with the guideline recommendations in general, but were about advantages of non-recommended insulins, which led, according to the healthcare professionals, to better applicability of those insulins to specific patients. The belief that guideline-recommended insulins were less effective, positive experience with other insulins and marketing from pharmaceutical companies were also identified as attitude-related barriers to prescribe guideline-recommended insulins. One additional category in the domain of attitudes was identified, namely the lack of uniformity in policy between healthcare professionals in the same practice. Only a small number of external barriers were identified, focusing on patient characteristics that prevented the use of recommended insulins, the availability of contradictory guidelines and other, mostly secondary care, healthcare providers initiating non-recommended insulins. No knowledge-related barriers were identified.ConclusionsThe prescription of non-recommended insulins in primary care is mostly driven by lack of agreement with the guideline recommendations and different interpretation of evidence. These insights can be used for the development of interventions to stimulate primary care practitioners to prescribe guideline-recommended insulins.

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

Introduction: This survey studied the knowledge and/or practices of drug injection techniques of diabetes patients, nurses, and physicians to guide formulating national standardized diabetes drug injection guidelines. Methods: Patients, nurses, and physicians were recruited from 259 primary, 150 secondary, and 100 tertiary care hospitals chosen using stratified cluster sampling. Their knowledge and/or practices of drug injection techniques were surveyed using the Diabetes Drug Injection Knowledge and Practice Questionnaire for Physicians, Nurses and Patients. Results: Totally 10694, 2643 and 2816 eligible questionnaires were collected from diabetes patients (92.3% type 2 diabetes) , physicians and nurses, respectively. Needlestick injury occurred in 13.0% patients, 19.8% patients had hypoglycemic episodes and 54.5% patients failed to attain the target HbA1c. Care setting and injection practice were significant determinants of needlestick injury, hypoglycemia and target HbA1c attainment. Overall, 48.9% physicians and 20.4% nurses had a poor knowledge domain score. Care setting, training, and diabetes care experience were significant determinants of diabetes drug injection knowledge domain scores in both physicians and nurses. Furthermore, >92% of the nurses properly performed the steps of injecting diabetes drugs. Needle injury occurred in 24.0% nurses. Care setting, nurse professional levels, and diabetes care experience were significant determinants of needlestick injury. Conclusions: This nationwide survey offers insights into diabetes drug injection knowledge and practices in China and provides evidence for drafting nationwide guidelines for diabetes drug injection techniques. Disclosure L.Guo: None. Q.Ji: None. S.Jiang: None. D.Liu: None. J.Liu: None. X.Ran: None. Y.Xue: None. Q.Zhang: None.

Diabetes Care Provider Perceptions Regarding Emerging Adults' Diabetes Self-Management Influences and Patient-Provider Visit Interactions Within a Safety-Net Hospital.

The increasing number of emerging adults with diabetes (EAWD) being cared for in adult health care settings requires a better understanding of the needs of EAWD and their interactions with adult health care providers (HCPs). This article describes findings from interviews with endocrinologists and diabetes nurses from a safety-net health care system to investigate HCPs' perspectives regarding influences on EAWD self-management and HCP interactions with EAWD. HCPs frequently perceived lower EAWD engagement in diabetes management, which was complicated by barriers such as the emotional burden of diabetes, busy lives and multiple responsibilities, and limited access to resources; however, HCPs valued the role of information and communication at visits in tailoring care for EAWD. Measures to tailor care should address the psychosocial burden related to the life stage goals and priorities of EAWD, identification of resources for EAWD and HCPs, and further elucidation of effective self-management guidance and communication strategies to support EAWD in safety-net settings.

IDF21-0175 Experiences of delivering virtual education workshops for children with type 1 diabetes during the Covid-19 pandemic

Background: Diabetes education is an essential element to achieve treatment objectives in children with type 1 diabetes mellitus (T1D) and it often involves group educations. Due to government group gathering restrictions during the Covid-19 pandemic, face-to-face group education were not possible. An alternative means of delivering group education is needed in this special time. With that, a series of virtual education workshops were designed. Aim: The study aimed to review the experience in conducting virtual education workshops for children and families with T1D during the Covid-19 pandemic. Method: The virtual workshops consisted of warm-up and ice-breaking games led by play therapists, followed by diabetes-related education workshops conducted by diabetes nurses, paediatric endocrinologists, and dietitians. Patients and families were invited to fill in a standard feedback questionnaire afterwards. Results: In the period of July 2020 to June 2021, a total of 10 virtual workshops were organised. A total of 33 children (13 boys and 20 girls) attended the workshops. The mean age of these patients was 9.5 +/- 3.8 years and the duration of T1D was 4.0 +/-3.3 years. Their mean HbA1c were 8.2 +/- 1.5%. A total of 22 responses on the feedback questionnaires were received. Among those who responded, 68% respondents had attended the virtual workshops for more than 2 times. The majority (86%) agreed that they had acquired new diabetes related knowledge from the workshops and 86% found the workshops interesting and enjoyable. Most (95%) reported that they could listen to instruction clearly and communicate causally in the virtual workshops. Only 32% strongly agreed that virtual workshops were the same as face-to-face workshops and 27% reported that they would prefer zoom to face-to-face workshop in the future. The commonest reasons for not joining virtual workshop in the future included unstable internet connection and feeling uneasy in virtual environment. Discussion: A safe, socially distanced method of delivering group education for children and families with T1D during the pandemic was possible and well-received. Virtual education workshops could be an alternative tool in delivering diabetes education. However, this could not totally replace face-to-face therapy.

Effectiveness of the Use of Animation and Gamification in Online Distance Education During Pandemic.

The study aimed to determine the effects on knowledge and motivation of animation and gamification in online distance education for a diabetes nursing course. This study was a randomized, controlled, prospective study implemented with 70 nursing students. The animation and gamification were applied to the experimental group. Data were collected using the “Diabetes Nursing Knowledge Test,” “Instructional Materials Motivation Survey,” and “Opinion Form on Diabetes Education Supported by Digital Instruments.” There was a statistical difference between the Diabetes Nursing knowledge scores of the groups after the course (P < .05). The students in the experimental group had significantly higher attention and satisfaction and total scores from the Motivation Scale for Teaching Material sub-dimensions compared with the control group (P < .001). The results of our study in generation Z nursing students demonstrated that the use of animation and gamification in online distance learning in nursing students increased their knowledge as well as motivation.

Improvements in Awareness and Testing Have Led to a Threefold Increase Over 10 Years in the Identification of Monogenic Diabetes in the U.K.

Maturity-onset diabetes of the young (MODY) is a rare monogenic form of diabetes. In 2009, >80% of U.K. cases were estimated to be misdiagnosed. Since then, there have been a number of initiatives to improve the awareness and detection of MODY, including education initiatives (Genetic Diabetes Nurse [GDN] project), the MODY probability calculator, and targeted next-generation sequencing (tNGS). We examined how the estimated prevalence of MODY and other forms of monogenic diabetes diagnosed outside the neonatal period has changed over time and how the initiatives have impacted case finding. U.K. referrals for genetic testing for monogenic diabetes diagnosed >1 year of age from 1 January 1996 to 31 December 2019 were examined. Positive test rates were compared for referrals reporting GDN involvement/MODY calculator use with those that did not. A diagnosis of monogenic diabetes was confirmed in 3,860 individuals, more than threefold higher than 2009 (1 January 1996 to 28 February 2009, n = 1,177). Median age at diagnosis in probands was 21 years. GDN involvement was reported in 21% of referrals; these referrals had a higher positive test rate than those without GDN involvement (32% vs. 23%, P < 0.001). MODY calculator usage was indicated in 74% of eligible referrals since 2014; these referrals had a higher positive test rate than those not using the calculator (33% vs. 25%, P = 0.001). Four hundred ten (10.6%) cases were identified through tNGS. Monogenic diabetes prevalence was estimated to be 248 cases/million (double that estimated in 2009 because of increased case finding). Since 2009, referral rates and case diagnosis have increased threefold. This is likely to be the consequence of tNGS, GDN education, and use of the MODY calculator.

The Significance of Repeated Education in Correcting Insulin Injection Techniques and Improving Glycemic Control

Background: The success of insulin therapy in achieving glycemic control highly relies on proper insulin injection practices. Proper insulin injection technique is crucial for optimizing the efficacy of insulin therapy. Therefore, it becomes imperative to train people with diabetes on standard insulin injection techniques. In some clinic settings, the education about the technique of injection may be delivered only once, and there is possibility that the patients can still commit mistakes while administering insulin. Ensuring proper insulin injection practices can help improve hemoglobin A1c (HbA1c) and achieve good glycemic control. Aim and Objective: This study aimed to assess the significance of wrong insulin injection techniques on poor glycemic control, and the impact of brief education sessions in inculcating proper insulin injection practices among patients with Type 2 diabetes mellitus (T2DM) was assessed in a real-world diabetes care setting. Methods: A retrospective analysis was conducted for the past 2 years among T2DM patients who exhibited improper injection techniques despite attending a 15-min training session. They were asked to fill in a questionnaire as well as their injection sites were examined. They were again made to attend the session and followed up for the succeeding 6 months to understand the underlying benefits of such training episodes. Results: Among people with T2DM, 126 individuals were identified with wrong injection practices. The mean HbA1c was 10.42% ± 2.33%, mean fasting blood glucose 199.60 ± 82.46 mg/dL, and mean postprandial blood glucose 236.70 ± 96.11 mg/dL. The participants' average number of insulin shots a day was 2.85 ± 1.11. The site of injection was incorrect in 20.17% of the patients; in 35.65%, the procedure of injecting was incorrect; and 11.97% did not follow injection site rotation. 18.80% of the patients presented with lipodystrophy or lipoatrophy. Conclusion: Improvement of insulin injection technique requires the involvement of all the key stakeholders in insulin therapy, these being diabetes educators and/or nurses, physicians, patients, and needle/device manufacturers. However, there is a need for clear guidance for diabetes educators and other health-care professionals so that they can, in turn, educate their patients to successfully self-manage their insulin therapy.

Experiences of overweight and obese patients with diabetes and practice nurses during implementation of a brief weight management intervention in general practice settings serving Culturally and Linguistically Diverse disadvantaged populations.

To explore the perspectives of overweight and obese patients with diabetes from culturally and linguistically diverse, and disadvantaged backgrounds, as well as practice nurses (PNs) during implementation of a brief PN-supported self-regulation nutrition strategy for weight management in general practice settings serving disadvantaged populations. During intervention implementation, semi-structured interviews were conducted with 12 patients and four nurses in two general practices located in metropolitan suburbs in Sydney, Australia. Patients and PNs found challenges related to cultural expectations and the requirement of patients to set and adhere to dietary change goals and behaviours. Although patients expressed high levels of satisfaction with PNs, the suitability of the intervention to this group was questioned by PNs. Obstacles were also encountered in delivering the intervention in a busy general practice setting. This pilot study provided initial evidence of the acceptability of a self-regulation nutrition intervention for weight management for overweight and obese patients with type 2 diabetes that was delivered by PNs. Cultural expectations of provider-patient roles, the type of intervention and flexibility in the workplace are important future considerations.