Diabetes Self-management Skills Research Articles

Effective Use of Paired Testing in Type 2 Diabetes

The purpose of this article is to discuss practical approaches to the use of self-monitoring of blood glucose (SMBG) in clinical practice using paired glucose testing. A rationale for SMBG use and innovative tools for data collection and analysis are presented. Method Health care professionals from various medical specialties collaborated to review current evidence regarding the value and utility of SMBG and to formulate professional opinions regarding use of SMBG. The literature review included key SMBG studies from 2002 through 2009. Established guidelines, position papers, and other evidence were also reviewed for this report. Reference Manager Software was used to search ISI Web of Science, PubMed, and Z39.50 site databases. Although the utility of SMBG in non-insulin-treated type 2 diabetes remains controversial, a recent report from the International Diabetes Federation recommends SMBG use in this population if it is used to educate/motivate individuals and/or monitor and adjust therapy. Health care providers must develop strategies to use SMBG in ways that address these criteria. Paired SMBG (testing before/after specific events) promotes diabetes knowledge and self-management skills and facilitates assessment of the impact of behavioral changes, medical nutrition therapy, and pharmacologic interventions on glycemic levels. New tools have been developed to assist in using paired testing in clinical practice.

Mobile Access to Health Information: An Integrative Technology Approach for the Development of Diabetes Self-Management Skills

Mobile Access to Health Information: An Integrative Technology Approach for the Development of Diabetes Self-Management Skills

Live Healthy Georgia ‐ Seniors Taking Charge outcome evaluation 2005–2006

The Live Healthy Georgia - Seniors Taking Charge Community Intervention is a partnership of the Division of Aging Services, Department of Public Health, aging services network, and University of Georgia. The purpose of the 2005–2006 Community Intervention was to improve physical activity, nutrition, and diabetes self-management skills in Georgia Older Americans Act Nutrition program participants in all 12 Planning Services Areas of Georgia, serving more than 30,000 older adults. The intervention was evaluated in 40 senior centers (N = 815, mean age = 74 y, 16% men, 84% women, 44% white, 55% African American, 1% other ethnicity/race). The outcome evaluation included pre-tests, interventions (up to 16 weekly sessions, 1 hr each), and post-tests designed to measure improvements in lifestyle and diabetes self-management. The intervention significantly (p < 0.05) improved time spent in physical activity; total intake of fruits and vegetables; diabetes self-management skills such as healthy eating, spacing carbohydrates, and checking feet; and A1c (decreased by 1% in those with initial A1c > 8%). Program materials are available at: www.livewellagewell.info/study/materials.htm.

Preconception care and women with or at risk for diabetes: implications for community intervention.

Preconception care and women with or at risk for diabetes: implications for community intervention.

Implementation and Evaluation of a Low-Literacy Diabetes Education Computer Multimedia Application

To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population. Five public clinics in Chicago, Illinois, participated in the study with computer kiosks installed in waiting room areas. Two hundred forty-four subjects with diabetes were randomized to receive either supplemental computer multimedia use (intervention) or standard of care only (control). The intervention includes audio/video sequences to communicate information, provide psychological support, and promote diabetes self-management skills without extensive text or complex navigation. HbA(1c) (A1C), BMI, blood pressure, diabetes knowledge, self-efficacy, self-reported medical care, and perceived susceptibility of complications were evaluated at baseline and 1 year. Computer usage patterns and implementation barriers were also examined. Complete 1-year data were available for 183 subjects (75%). Overall, there were no significant differences in change in A1C, weight, blood pressure, knowledge, self-efficacy, or self-reported medical care between intervention and control groups. However, there was an increase in perceived susceptibility to diabetes complications in the intervention group. This effect was greatest among subjects with lower health literacy. Within the intervention group, time spent on the computer was greater for subjects with higher health literacy. Access to multimedia lessons resulted in an increase in perceived susceptibility to diabetes complications, particularly in subjects with lower health literacy. Despite measures to improve informational access for individuals with lower health literacy, there was relatively less use of the computer among these participants.

Diabetes self-management among low-income spanish-speaking patients: A pilot study

The prevalence of type 2 diabetes and diabetes-related morbidity and mortality is higher among low-income Hispanics when compared to that of Whites. However, little is known about how to effectively promote self-management in this population. The objectives were first to determine the feasibility of conducting a randomized clinical trial of an innovative self-management intervention to improve metabolic control in low-income Spanish-speaking individuals with type 2 diabetes and second to obtain preliminary data of possible intervention effects. Participants for this pilot study were recruited from a community health center, an elder program, and a community-wide database developed by the community health center, in collaboration with other agencies serving the community, by surveying households in the entire community. Participants were randomly assigned to an intervention (n = 15) or a control (n = 10) condition. Assessments were conducted at baseline and at 3 months and 6 months postrandomization. The intervention consisted of 10 group sessions that targeted diabetes knowledge, attitudes, and self-management skills through culturally specific and literacy-sensitive strategies. The intervention used a cognitive-behavioral theoretical framework. Recruitment rates at the community health center, elder program, and community registry were 48%, 69%, and 8%, respectively. Completion rates for baseline, 3-month, and 6-month assessments were 100%, 92%, and 92%, respectively. Each intervention participant attended an average of 7.8 out of 10 sessions, and as a group the participants showed high adherence to intervention activities (93% turned in daily logs, and 80% self-monitored glucose levels at least daily). There was an overall Group x Time interaction (p = .02) indicating group differences in glycosylated hemoglobin over time. The estimated glycosylated hemoglobin decrease at 3 months for the intervention group was -0.8% (95% confidence intervals = -1.1%, -0.5%) compared with the change in the control group (p = .02). At 6 months, the decrease in the intervention group remained significant, -0.85% (95% confidence intervals = -1.2, -0.5), and the decrease was still significantly different from that of the controls (p = .005). There was a trend toward increased physical activity in the intervention group as compared to that of the control group (p = .11) and some evidence (nonsignificant) of an increase in blood glucose self-monitoring in the intervention participants but not the control participants. Adjusting for baseline depressive scores, we observed a significant difference in depressive symptoms between intervention participants and control participants at the 3-month assessment (p = .02). Low-income Spanish-speaking Hispanics are receptive to participate in diabetes-related research. This study shows that the pilot-tested diabetes self-management program is promising and warrants the conduct of a randomized clinical trial.

The evidence for the effectiveness of medical nutrition therapy in diabetes management.

Numerous advances in diabetes management and medical nutrition therapy (MNT) for individuals with diabetes make this an exciting time. Historically, a challenge to proving the benefit of MNT has been the lack of clinical and behavioral research. In recent years, however, evidence-based outcomes research that documents the clinical effectiveness of MNT in diabetes has been reported. The term “medical nutrition therapy” was introduced in 1994 by the American Dietetic Association to better articulate the nutrition therapy process. It is defined as the use of specific nutrition services to treat an illness, injury, or condition and involves two phases: 1 ) assessment of the nutritional status of the client and 2 ) treatment, which includes nutrition therapy, counseling, and the use of specialized nutrition supplements (1). MNT for diabetes incorporates a process that, when implemented correctly, includes: 1 ) an assessment of the patient’s nutrition and diabetes self-management knowledge and skills; 2 ) identification and negotiation of individually designed nutrition goals ; 3 ) nutrition intervention involving a careful match of both a meal-planning approach and educational materials to the patient’s needs, with flexibility in mind to have the plan be implemented by the patient; and 4) evaluation of outcomes and ongoing monitoring. These four steps are necessary to assist patients in acquiring and maintaining the knowledge, skills, attitudes, behaviors, and commitment to successfully meet the challenges of daily diabetes self-management (2). The primary purpose of this article is to review the evidence for the effectiveness of MNT in diabetes, both as an independent variable and in combination with other components of diabetes self-management training (DSMT). In addition, the recent studies that have demonstrated the effectiveness of lifestyle intervention, which included MNT, in preventing type 2 diabetes will be highlighted. Evidence from several studies that supports the cost-effectiveness of MNT in diabetes will also be …

A Nutrition Center Provides Practical Application for Teaching Diabetes Self-Management Skills

According to the American Diabetes Association (ADA), the incidence of diabetes in mis area is 1 in 14, much higher than the 1 in 20 national average. In spite of the high incidence of diabetes, there are no Endocrinologists or Diabetologists in mis community.To the fill the void, Certified Diabetes Educators have developed a Diabetes Self-Management Program in an off-campus clinic affiliated with a not-for-profit health care system. The Program is located in a structure containing a Nutrition Center consisting of a demonstration kitchen, a simulated grocery store, a resource room (ADA bookstore, computer with Internet access, VCR with videos, professional journals and brochures), an exercise room and classrooms.Participants receive an individual assessment/consultation with both an R.D. and R.N. plus 10 hours of group classes. All participants are encouraged to bring family/significant others to the classes. Hospital in-patients are taught basic survival skills only with referral to the Program for extensive education in the out-patient setting. Patients also are referred from physician practices.A team approach is used to teach the Program based on the ADA's Living with Diabetes. Self-efficacy, or the confidence in one's own ability to achieve a specific behavior, is the basis for behavioral change. Education techniques are geared to adult learners, consisting of brainstorming, practical application (supermarket tours, cooking demos, foot care, meter usage), contracting and feedback for goal development, belief change and persuasion.Physician referral is required for third-party reimbursement and follow-up is sent to the physician after completion of the course. Hemoglobin Ale is requested from the physician or clinic at 3, 6 and 12 month intervals for outcome measures.

Participation in Outpatient Diabetes Education Programs: How Many- Patients Take Part and How Representative Are They?

Little research has been conducted on the role of participation in programs that teach diabetes self-management skills. This paper reviews recent studies on diabetes educational programs to determine what is known about participation, and then reports our experience in recruiting patients for a program that teaches diabetes self-care skills to persons age 60 and older. Few studies have reported data on participation rates in such programs, and only one study provided information on characteristics of patients who participated versus those who did not. In our study, patients over age 70, and those with whom we initiated contact by means of a letter from their health care provider, were less likely to participate than were younger patients and those who initiated contact with us. It is recommended that future research include information on the percentage and representativeness of patients who participate in diabetes education programs. Studies should also describe their target population, procedures used to recruit participants, and program characteristics that might affect participation.

A model clinical program for patients with diabetes and vision impairment.

A program was developed to improve independence, self-esteem, and glycemic control in patients with diabetes and blindness. Twenty-nine individuals with both insulin-dependent and noninsulin-dependent diabetes mellitus entered 12-week programs that included education focusing on diabetes self-management skills for the visually impaired, monitored exercise sessions, and group support. Glycated hemoglobin values fell from 13.0% +/- 0.6% (SEM) to 11.4% +/- 0.5% (P = .001). Exercise tolerance in a 12-minute walk test improved from 0.48 +/- 0.04 to 0.64 +/- 0.05 miles (P = .001). Marked improvements occurred in psychosocial indices, demonstrated through changes in the Rand Mental Health Index from 155 +/- 6 to 174 +/- 5 (P = .0001), the Rosenberg Self-Esteem Scale from 22 +/- 1 to 19 +/- 1 (P = .001), the Zung Depression Scale from 0.50 +/- 0.02 to 0.44 +/- 0.02 (P = .001), and the Diabetes Self-Reliance Test from 60 +/- 3 to 74 +/- 2 (P = .0001).

Psychosocial Profiles in Patients With Visual Impairment Due to Diabetic Retinopathy

The psychological impact of vision loss due to diabetic retinopathy is compounded by the loss of diabetes self-management skills. The appropriate role and timing for rehabilitative intervention has not been determined. Twenty-nine individuals with diabetes mellitus, 16 with stable visual impairment and 13 with fluctuating and transitional visual impairment, underwent psychological assessment before and after entering into a specially designed rehabilitation program. Low levels of performance were rehabilitation program. Low levels of performance were demonstrated by the Rosenberg Self-Esteem Scale and the Diabetes Self-Reliance Test in both groups. The Minnesota Multiphasic Personality Inventory, the Zung Self-Rating Depression Scale, and the Rand Mental Health Index suggested that subjects with stable vision impairment were moderately compensated relative to the transitional group, although the former group may have been totally blind. Both groups demonstrated significant improvements in psychological profiles after the program. It is suggested that a rehabilitation program may be of clinical benefit early in the course of vision loss associated with diabetic retinopathy.