Evolving self-care in individuals with schizophrenia and diabetes mellitus

Individuals with schizophrenia have higher rates of diabetes mellitus as compared with the general population, but little is known about their diabetic self-care. This grounded theory study was conducted to develop a theory of self-care for individuals with comorbid schizophrenia/schizoaffective disorder and diabetes. Twenty-six interviews were conducted among 11 respondents with varying degrees of ability to care for these coexisting illnesses. Respondents identified psychiatric symptoms as a major barrier to diabetic self-care. The resulting theory of Evolving Self-Care describes the process by which respondents developed self-care health beliefs over time to help them successfully manage their psychiatric disorder and diabetes. Categories include mastering mental illness, accommodating diabetes, and striving for health. When providing care to patients with schizophrenia/schizoaffective disorder and diabetes, advanced registered nurse practitioners are encouraged to provide education about the negative consequences of psychosis on diabetes self-care.     

Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus

AIM OF THE STUDY: Factors associated with adherence to self-care and glycaemic control were studied in 213 people with insulin-dependent diabetes mellitus using a self-report questionnaire and a biochemical indicator (glycosylated haemoglobin). METHODS: The data were collected in the Oulu Health Center and the Central Hospital of Lapland in Northern Finland. The response rate was 76%. In order to verify the reliability and validity of the instruments, we used correlation coefficients, factor analysis and item-total analysis. Internal consistency was checked by Cronbach's alpha. The connections between self-care and the background variables were examined by cross-tabulation. FINDINGS: The majority of subjects accomplished their insulin treatment as scheduled, but had more difficulties with the other aspects of self-care. According to the findings, a fifth (19%) of the respondents were neglecting their self-care. The others undertook flexible (46%), regimen-adherent (16%) or self-planned self-care (19%). The subjects who were adherent to self-care had better metabolic control than those who neglected self-care. According to logistic regression analysis, poor metabolic control (P=0.003), smoking (P=0.009) and living alone (P=0.014) were associated with neglect of self-care. Gender, concurrent diseases and complications as a result of diabetes increased the risk, but had no significant association with adherence to or neglect of self-care. CONCLUSION: The findings demonstrated that adherence to self-care does not always lead to good metabolic control, but neglect of self-care is likely to lead to poor metabolic control.     

奥瑞姆自理模式联合健康教育对提高糖尿病病人足部自护能力的效果

糖尿病足部病变(DMR)是糖尿病最常见的并发症,已成为糖尿病病人最主要致残、致死原因之一.有研究表明,糖尿病病人缺乏保护足的知识教育者,截肢的危险性(RR)增加3.2倍,强化足部护理教育有利于减少糖尿病足的发生[1,2].     

The effect of education given to patients with type 2 diabetes mellitus on self-care

This research was performed as a single group pretest--posttest experimental design to determine the effect of education given to patients with type 2 diabetes mellitus on self-care. The research was performed between October 2007 and June 2008 in the Internal Medicine Outpatient Clinics located in A and B Blocks of Erzincan State Hospital. The research population included 100 patients with type 2 diabetes mellitus who attended the above mentioned units between the specified dates and met the inclusion criteria. Patients were subjected to a pretest using a patient identification form, Diabetes Self-Care Scale (DSCS) form in Turkish language and metabolic control parameters. A statistically significant difference was found between the mean values of pre-education and posteducation DSCS scores with an increase in mean posteducation scores. These results demonstrate that the education given to patients improves their self-care and metabolic control variables.     

Doing my best: poverty and self-care among individuals with schizophrenia and diabetes mellitus

Diabetes mellitus (DM) is more common among individuals with schizophrenia/schizoaffective disorders than among the general population. Eleven mental health consumers diagnosed with comorbid schizophrenia/schizoaffective disorder and DM participated in a grounded theory study that examined their approaches to diabetic self-care. The resulting model, Evolving Self-Care, describes the process by which respondents developed health beliefs about the self-care of dual illnesses. One subcategory of the model, Doing My Best, was further analyzed to examine the social context of respondents' diabetic self-care. Limited financial resources and material deprivation interfered with access to the resources necessary for adequate diabetic self-care. Mental health providers are encouraged to provide treatment and patient education that are consistent with the real world living situations of individuals with schizophrenia. Policymakers at the federal and state levels need to address the impact of financing of mental health services on the overall health of vulnerable individuals with serious mental illnesses.     

Assessing progression to impaired glucose tolerance and type 2 diabetes mellitus

BACKGROUND: A prospective evaluation of the relationship between insulin secretion and insulin sensitivity, derived from the fasting state, is needed in clinical practice in order to identify the worsening of glucose metabolism. In this study the authors examine whether the product of insulin sensitivity and insulin secretion, assessed from the fasting state, predicts progression from normal glucose tolerance (NGT) to impaired fasting glucose (IFG) and from impaired glucose tolerance (IGT) to type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A cohort of 300 subjects with NGT and 75 subjects with IGT were followed up over a 5-year period. Insulin sensitivity was calculated using the Belfiore index (B) and insulin secretion by the homeostasis model analysis beta-cell (HOMA-beta cell) index: the product of B-beta is expressed as: (40 x Ins(0) pmol L(-1))/Glu(0) mmol L(-1){[(Glu(0) mmol L(-1)x Ins(0) pmol L(-1)) + 1] - 3.5[(Glu(0) mmol L(-1) x Ins(0) pmol L(-1)) - 1]}, where Glu(0) is fasting glucose and Ins(0) is fasting insulin. RESULTS: From baseline at the end of the follow-up period, the product B-beta decreased 10.7% and 52.2% in progressors to IGT and T2DM, respectively. The product B-beta predicts the progression from NGT to IGT [relative risk (RR) 2.7, CI(95%) 1.2-9.1] and from IGT to T2DM (RR 5.3, CI(95%) 1.3-8.55). The cut-off point for the product B-beta that better predicts progression from NGT to IGT is 0.25 (sensitivity 88%, specificity 92%) and from IGT to T2DM 0.15 (sensitivity 92%, specificity 95%). CONCLUSIONS: Adaptation of insulin secretion to compensate for decreased insulin sensitivity during transition to IGT and T2DM can be successfully assessed with simple measures derived from the fasting state. The product B-beta predicts the development to IGT and T2DM.     

Orem自理模式在妊娠期糖尿病患者中的应用

目的探讨Orem自理模式在妊娠期糖尿病（gestational diabetes mellitus,GDM）患者中的应用效果。方法选择104例GDM患者按入院次序分为实验组（55例）和对照组（49例）,实验组采用Orem自理模式护理方法,对照组采用常规护理方法。观察两组患者妊娠、分娩情况和干预前后两组患者空腹血糖（fasting plasma glucose,FPG）及糖化血红蛋白（glycated hemoglobin,HbA1c）情况的差异。结果实验组患者正常妊娠率和自然分娩率均较对照组高（均P〈0.05）;干预后实验组患者FPG下降水平和HbA1c控制水平优于对照组（均P〈0.05）。结论 Orem自理模式可提高GDM患者围产期质量及有效控制血糖水平。     

2型糖尿病患者疾病不确定感与自护行为的相关性研究

目的调查2型糖尿病(T2DM)患者疾病不确定感和自护行为状况,并探讨两者间的关系。方法应用疾病不确定感量表和改良自护行为量表,对102例2型糖尿病患者进行调查。结果 2型糖尿病患者的疾病不确定感为中等程度,自护行为中总体饮食、具体饮食和运动得分较高,进行血糖监测者占34.31%,进行足部护理者占28.43%,疾病不确定感与自护行为存在负相关。结论护理人员应对患者的疾病不确定感进行评估,给予个体化护理干预,降低疾病不确定感,改善自护行为。     

房山地区糖尿病病人自我照顾行为的调查研究

[目的]探讨房山地区糖尿病病人的自我照顾行为.[方法]采用问卷形式对房山地区77例糖尿病病人的自我照顾行为进行调查.[结果]糖尿病病人对足部护理及运动疗法的重视程度不够,不能进行有效的足部护理,不能坚持运动.[结论]加强对糖尿病病人的健康教育,普及糖尿病知识,做好自我护理、自我保健,协助病人有效地控制糖尿病,预防并发症的发生.     

个性化自我护理管理对妊娠期糖尿病后罹患2型糖尿病产妇的防控效果

目的探讨个性化自我护理管理对妊娠期糖尿病后罹患2型糖尿病(T2DM)产妇的防控效果。方法选取2016年1月至2018年12月于我院就诊的50例妊娠期糖尿病患者作为研究对象,随机将其等分为观察组和对照组,对照组采用常规护理,观察组在此基础上采用个性化自我护理管理,比较两组产妇罹患T2DM的发生情况、空腹血糖、糖化血红蛋白,以及产后6个月自我护理能力及健康促进生活方式评分。结果观察组罹患T2DM率低于对照组(P<0.05);观察组空腹血糖、糖化血红蛋白水平均低于对照组(P<0.05);观察组产后6个月的健康知识水平、自我责任感、自我护理技能评分均高于对照组(P<0.05);观察组术后6个月的健康责任感、压力管理、人际关系、躯体活动、营养水平均高于对照组(P<0.05)。结论个性化自我护理管理用于妊娠期糖尿病的护理干预过程中,能够起到降低罹患T2DM风险,改善血糖水平,提高的自我管理能力,促进健康生活方式水平提高,值得临床推广应用。     

自护理论在子宫肌瘤合并糖尿病围手术期护理中的应用

目的:探讨自护理论在子宫肌瘤合并糖尿病围手术期护理中的应用。方法:将2007年12月～2009年12月实行子宫肌瘤合并糖尿病手术的166例患者随机分为观察组86例和对照组80例,观察组患者采用自护理论进行护理,对照组患者采用常规护理方法进行护理,比较两组患者术前、术后血糖控制情况、术后下床活动时间、肛门排气时间、拔除尿管时间及拔尿管后自主排尿情况。结果:观察组患者血糖控制情况、术后肛门排气、拔尿管后自主排尿及术后下床活动情况明显好于对照组(P0.01)。结论:在子宫肌瘤合并糖尿病患者手术前后护理中应用自护理论可促进患者身体早日康复,值得在临床推广应用。     

Assessing effect of mixing insulins by glucose-clamp technique in subjects with diabetes mellitus

The glucose-clamp technique was used to assess the effect on insulin activity of mixing clinically relevant doses of short- and longer-acting insulins in insulin-treated diabetic subjects. Mixtures of porcine regular and lente insulins resulted in a reduction in activity of the mixture compared with separate injection that was more apparent with premixing for 5 min before injecting than with premixing for 2 min. These findings were not explained by differences in volume of the injected insulin preparations. Mixing of porcine regular and bovine ultralente insulins for 2 min before injecting resulted in a reduced activity compared with separate injection. No difference in activity was obvious for porcine regular and NPH insulins given separately or premixed for 5 min. A reduction of activity during the 1st h after injection was observed when separate injection of one brand of these insulins (Velosulin or Insulatard) was compared with the manufactured mixture (Mixtard). These results indicate that premixing regular and NPH insulins in a 1-to-2 ratio does not alter the biological activity compared with separate administration of the insulins. However, the mixing of regular and insulin-zinc suspensions results in a loss of insulin activity, the magnitude of which depends on the time between mixing and injecting the insulin. The clinical significance of the effect of mixing on the efficacy of subcutaneous insulin therapy should be considered in the context that this is only one of many factors that may affect the activity of subcutaneously injected insulin.     

Assessing instruments in a Cuban American population with type 2 diabetes mellitus.

The purposes of this pilot study were to identify and adapt instruments for future use in assessing diabetes self-management in a sample of Cuban Americans with Type 2 diabetes. Eight instruments were selected from the literature, translated into Spanish, and administered to a sample of 20 Cuban Americans with Type 2 diabetes. Psychometric properties were examined along with clarity of wording, cultural appropriateness, and ease of use. Reliability data were compared, when possible, with original scores generated with non-Cuban populations. Results indicated that reliability scores among populations were similar. Support for using these instruments in clinical practice to assess initial knowledge and beliefs about aspects of diabetes management and to monitor changes is provided.     

2型糖尿病病人社会支持和自护行为的相关性研究

[目的]探讨2型糖尿病病人社会支持与自护行为的相关性。[方法]采用2型糖尿病自护行为量表与社会支持评定量表对56例确诊为2型糖尿病6个月以上的住院病人进行问卷调查。[结果]56例2型糖尿病病人社会支持总分为(33.68±4.08)分,自护行为总分为(81.67±3.75)分。2型糖尿病病人社会支持与自护行为相关系数为0.875(P<0.01)。[结论]2型糖尿病病人社会支持与自护行为呈正相关。     

行为转变理论在糖尿病患者足部自护行为现况调查中的应用

目的应用行为转变理论了解糖尿病患者足部自护行为现况。方法自行设计患者基本情况调查表和足部自护行为阶段评价表,对广州市多个社区符合纳入标准的糖尿病患者进行足部自护行为阶段的现况调查。结果患者271例,分布在前意向阶段65例、意向阶段76例、准备阶段96例、行动阶段27例、维持阶段7例。不同学历、不同职业患者间足部自护行为有显著差异,相关分析结果显示不同行为阶段与空腹血糖、糖化血红蛋白、体重、体重指数存在负相关。结论目前糖尿病患者足部自护行为较差,要重视健康教育。