Improving glycemic control in older adults using a videophone motivational diabetes self-management intervention

Older adults experience the greatest burden of diabetes. Resources must be available and accessible to empower older adults to perform diabetes self-care. The purpose of this study was to evaluate a videophone motivational interviewing (MI) diabetes self-management education (DSME) intervention to improve glycemic control of rural older adults. Sixty-six participants (mean age = 64.9 years, range 60-81) with uncontrolled diabetes were enrolled in a 6-month videophone intervention. Experimental group participants (n = 34) received weekly, then monthly, videophone MI DSME calls, whereas control participants (n = 32) received monthly videophone healthy-lifestyle education calls. Although both groups experienced a decreased HbA1c, there was a statistically significant difference in experimental group mean values (p = .015), but not the control group (p = .086). The experimental group demonstrated statistically significant increases in diabetes knowledge (p = .023) and diabetes self-efficacy (p = .002). Experimental group participants with high self-efficacy in contrast to low self-efficacy had a statistically significant decrease in HbA1c (p = .043).     

Factors associated with glycemic control and diabetes self-care among outpatients with schizophrenia and type 2 diabetes

We investigated the influence of the severity of schizophrenia on diabetes self-care and glycemic control among outpatients with schizophrenia and diabetes. We conducted interviews with 38 participants and reviewed their clinical charts. The mean hemoglobin A1c (HbA1c) level in the full study population was 7.65%. There was no difference in the HbA1c level between two groups of subjects classified by the severity of schizophrenia. Some diabetes self-care indicators were significantly lower in patients with high Brief Psychiatric Rating Scale scores (P < .05). Although psychotic symptoms do not appear to affect glycemic control, psychotic symptoms might affect diabetes self-care behaviors in people with schizophrenia.     

动态血糖监测图谱在糖尿病健康教育中的应用研究

目的 探讨动态血糖监测图谱在糖尿病患者健康教育中的应用效果。 方法 212例糖尿病患者随机分为对照组与观察组各106例。对照组在住院期间参加糖尿病健康教育集体讲座,观察组在参加健康教育集体讲座的基础上,利用患者本人动态血糖监测图谱结果进行一对一教育。观察2组糖尿病知识理论成绩、自护行为能力评分、糖化血红蛋白值的变化。 结果 观察组理论成绩高于对照组,自护行为能力评分高于对照组,出院3个月糖化血红蛋白值明显低于对照组。 结论 动态血糖监测图谱可对患者的饮食及运动等行为产生持续影响,促进糖尿病患者健康行为的建立。     

Cost and benefits of a multidisciplinary intensive diabetes education programme

OBJECTIVES: To determine the cost and benefits of an intensive diabetes education programme for patients with prolonged self-management problems and to determine the inclusion criteria for optimal outcomes. METHODS: Sixty-one participants of a multidisciplinary intensive diabetes education programme (MIDEP) were measured before they started the intervention (T0), and at 1-year follow-up (T1). Data on glycaemic control (HbA1c), diabetes-related distress (PAID) and costs were obtained. Changes over time were analysed and means at T0 and T1 were compared to a reference group of 230 non-referred consecutive outpatients. The number needed to treat (NNT), that is, the number of patients to be treated to achieve one successful case, was calculated for different baseline values of HbA1c and PAID to determine optimal inclusion criteria. RESULTS: Diabetes-related costs decreased significantly and participants improved significantly in HbA1c and diabetes-related distress following MIDEP. HbA1c and distress reached the levels of the reference group. The T1 costs remained higher than in the reference group, but the reduction in costs outweighed the intervention costs. Including patients with baseline HbA1c>or=8.0% and/or PAID scores>or=40 would improve the NNT to achieve clinically relevant outcomes, while 76% of the patients matched these inclusion criteria. CONCLUSIONS: MIDEP is effective in improving glycaemic control and diabetes-related distress for patients with prolonged self-management difficulties. Besides the immediate reduction in costs found in the present study, improved glycaemic control may reduce future costs of diabetic complications. Stricter inclusion criteria with respect to HbA1c and PAID scores may further improve the programme's efficiency.     

糖尿病联络护士个体化出院随访在非内分泌科糖尿病患者中的应用效果

目的 探讨糖尿病联络护士(diabetes liaison nurse,DLN)个体化出院随访在改善非内分泌科糖尿病患者自我管理行为及提高患者糖尿病相关知识、态度及自我管理行为的效果。 方法 将纳入的74例非内分泌科住院的2型糖尿病患者随机分为实验组和对照组,每组各37例,对照组出院后接受病区随访护士提供的3个月常规出院随访,实验组出院后接受DLN提供的3个月个体化出院随访。比较2组干预前及干预6个月后糖尿病相关知识、态度、自我管理行为及糖化血红蛋白的改善效果。结果 干预后2组糖尿病相关知识、态度、自我管理行为在时间效应和交互效应上差异有统计学意义,糖化血红蛋白水平在主效应及时间效应上差异有统计学意义。结论 糖尿病联络护士个体化出院随访能显著提高非内分泌科糖尿病患者的糖尿病相关知识、态度、自我管理行为,降低非内分泌科糖尿病患者的糖化血红蛋白水平。     

Motivational interviewing-based health coaching as a chronic care intervention

Objective  To evaluate the impact of motivational interviewing-based health coaching on a chronically ill group of participants compared with non-participants. Specifically, measures that could be directly attributed to a health coaching intervention on chronic illness were assessed.
Design  Quasi-experimental study design.
Setting  A large medical university in the north-west United States.
Methods  One hundred and six chronically ill programme participants completed a health risk survey instrument prior to enrolment and again at approximately 8 months. Outcomes were compared with 230 chronically ill non-participants who completed the survey twice over a similar time frame. Inverse probability of treatment weights were used in conjunction with the propensity score to correct for selection bias.
Results  Compared with non-participants, programme participants improved their self-efficacy ( P  = 0.01), patient activation ( P  = 0.02), lifestyle change score ( P  = 0.01) and perceived health status ( P  = 0.03). Fewer participants increased their stages of change risk over time than non-participants ( P  < 0.01), and more participants decreased their stages of change risk over time than non-participants ( P  = 0.03).
Conclusion  These results support motivational interviewing-based health coaching as an effective chronic care management intervention in impacting outcome measures that could also serve well as a proxy in the absence of other clinical or cost indices.     

Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits

OBJECTIVE: To evaluate the effectiveness of a cluster visit model led by a diabetes nurse educator for delivering outpatient care management to adult patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS: This study involved a randomized controlled trial among patients of Kaiser Permanente's Pleasanton, CA, center who were aged 16-75 years and had either poor glycemic control (HbA1c > 8.5%) or no HbA1c test performed during the previous year. Intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse educator, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10-18 patients/month for 6 months. Outcomes included change (from baseline) in HbA1c levels; self-reported changes in self-care practices, self-efficacy, and satisfaction; and utilization of inpatient and outpatient health care. RESULTS: After the intervention, HbA1c levels declined by 1.3% in the intervention subjects versus 0.2% in the control subjects (P < 0.0001). Several self-care practices and several measures of self-efficacy improved significantly in the intervention group. Satisfaction with the program was high. Both hospital (P = 0.04) and outpatient (P < 0.01) utilization were significantly lower for intervention subjects after the program. CONCLUSIONS: A 6-month cluster visit group model of care for adults with diabetes improved glycemic control, self-efficacy, and patient satisfaction and resulted in a reduction in health care utilization after the program.     

The relationship between knowledge of recent HbA1c values and diabetes care understanding and self-management

OBJECTIVE: Knowledge of one's actual and target health outcomes (such as HbA(1c) values) is hypothesized to be a prerequisite for effective patient involvement in managing chronic diseases such as diabetes. We examined 1) the frequency and correlates of knowing one's most recent HbA(1c) test result and 2) whether knowing one's HbA(1c) value is associated with a more accurate assessment of diabetes control and better diabetes self-care understanding, self-efficacy, and behaviors related to glycemic control. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional survey of a sample of 686 U.S. adults with type 2 diabetes in five health systems who had HbA(1c) checked in the previous 6 months. Independent variables included patient characteristics, health care provider communication, and health system type. We examined bivariate and multivariate associations between each variable and the respondents' knowledge of their last HbA(1c) values and assessed whether knowledge of HbA(1c) was associated with key diabetes care attitudes and behaviors. RESULTS: Of the respondents, 66% reported that they did not know their last HbA(1c) value and only 25% accurately reported that value. In multivariate analyses, more years of formal education and high evaluations of provider thoroughness of communication were independently associated with HbA(1c) knowledge. Respondents who knew their last HbA(1c) value had higher odds of accurately assessing their diabetes control (adjusted odds ratio 1.59, 95% CI 1.05-2.42) and better reported understanding of their diabetes care (P < 0.001). HbA(1c) knowledge was not associated with respondents' diabetes care self-efficacy or reported self-management behaviors. CONCLUSIONS: Respondents who knew their HbA(1c) values reported better diabetes care understanding and assessment of their glycemic control than those who did not. Knowledge of one's HbA(1c) level alone, however, was not sufficient to translate increased understanding of diabetes care into the increased confidence and motivation necessary to improve patients' diabetes self-management. Strategies to provide information to patients must be combined with other behavioral strategies to motivate and help patients effectively manage their diabetes.     

"看图对话"互动式教育在2型糖尿病患者血糖控制中的应用

目的 探讨"看图对话"互动式教育对2型糖尿病患者血糖控制的影响.方法 将84例门诊新诊断的2型糖尿病患者随机分成试验组和对照组各42例,试验组由教育护士利用国际糖尿病联盟推出的4幅"看图对话"工具进行互动式教育,对照组只接受糖尿病常规教育.现察干预前后两组患者的空腹血糖、餐后2h血糖、糖化血红蛋白(HbAlc)3个代谢指标及自护行为能力有无变化.结果 干预后试验组的空腹血糖、餐后2h血糖、HbAlc控制方面优于对照组,差异有统计学意义(P＜0.05).两组患者的各项自护行为能力(除遵医嘱服药外)比较,差异均有统计学意义(P＜0.01).结论 "看图对话"互动式教育对帮助2型糖尿病患者提高自护行为能力有促进作用,患者的血糖控制更加理想.     

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。     

Long-term effects of an intensive-practical diabetes education program on HbA1c and self-care

ObjectiveThe purpose of this study was to implement an intensive and practical diabetes education program (DEP) and evaluate its long-term effects and its impact on psychosocial variables. It was hypothesized that the DEP would improve patients' metabolic control (A1c hemoglobin – HbA1c), technical knowledge, self-efficacy and frequency of self-care and decrease barriers and other parameters such as the body mass index (BMI) and LDL cholesterol. These results should be maintained at one-year follow-up.Design and settingThe sample was composed of 40 patients with diabetes type I who attended a diabetes outpatient clinic. A repeated measures design, considering medical and psychosocial variables at six months and one year, was used.ResultsResults have statistical and clinical implications. They revealed significant changes that were maintained at one-year follow-up in HbA1c, barriers to self-care, frequency of self-care, knowledge about the disease and perceived self-efficacy. The areas of self-care where the fewest changes took place were diet and exercise, which are highly related to cardiovascular risk factors and are very present in patients with diabetes. Specifically, no changes were observed in BMI or LDL cholesterol.ConclusionThe intensive DEP proved to be effective, although specific efforts should be made in certain areas to ensure longer-lasting benefits. Besides, including not only educational but also psychological strategies in patients' education to motivate them to make real lifestyle changes should be a priority in the design of any DEP.     

Diabetes in urban African-Americans. XVII. Availability of rapid HbA1c measurements enhances clinical decision-making.

OBJECTIVE: To assess the impact of rapid-turnaround HbA1c results on providers' clinical decision-making and on follow-up HbA1c levels. RESEARCH DESIGN AND METHODS: The research design was a randomized clinical trial in which rapid HbA1c results were made available to providers on even days of the month (rapid, n = 575), but delayed by 24 h on odd days (conventional, n = 563). Adjustment of therapy for patients with type 2 diabetes was considered appropriate if therapy was intensified for HbA1c values >7% or not intensified for HbA1c values < or =7%. A post-hoc analysis was also performed using patients (n = 574) who returned for follow-up 2-7 months later to ascertain the effect of rapid HbA1c availability on subsequent glycemic control. RESULTS: Rapid HbA1c availability resulted in more appropriate management compared with conventional HbA1c availability (79 vs. 71%, P = 0.003). This difference was due mainly to less frequent intensification when HbA1c levels were < or =7% (10 vs. 22%, P < 0.0001) and slightly to more frequent intensification for patients with HbA1c values >7% (67 vs. 63%, P = 0.33). For both groups, intensification was greatest for patients on insulin (51%) compared with patients on oral agents (35%) and diet alone (14%) (P < 0.0001). Regression analysis confirmed that providers receiving conventional HbA1c results were more likely to intensify therapy in patients who already had HbA1c levels < or =7%. Over 2-7 months of follow-up, HbA1c rose more in patients with conventional HbA1c results compared with rapid results (0.8 vs. 0.4%, P = 0.02). In patients with initial HbA1c >7%, rapid HbA1c results had a favorable impact on follow-up HbA1c independent of the decision to intensify therapy (P = 0.03). CONCLUSIONS: Availability of rapid HbA1c determinations appears to facilitate diabetes management. The more favorable follow-up HbA1c profile in the rapid HbA1c group occurs independently of the decision to intensify therapy, suggesting the involvement of other factors such as enhanced provider and/or patient motivation.     

实施自我管理教育对妊娠糖尿病患者血糖与自护能力的影响

目的 探讨自我管理教育对妊娠糖尿病患者血糖与自护能力的影响.方法 对123例妊娠糖尿病患者实施自我管理教育,通过成立妊娠糖尿病教育管理团队,制订自我管理教育计划及对患者进行疾病知识、自我技能与情绪的管理,观察患者入组时与教育后3个月血糖与糖化血红蛋白(HbAlc)水平、自护能力及健康行为的变化.结果 123例患者通过自我饮食、运动、血糖及情绪管理教育后取得良好效果,血糖与HbAlc的水平、自护能力及健康行为明显改善.结论 对妊娠糖尿病患者实施团队自我管理教育能明显改善患者的饮食、运动、血糖等各方面自我管理能力,有效控制妊娠糖尿病患者的血糖与HbAlc水平,提高患者的自护能力.     

应用目标设定策略改变糖尿病患者行为的实践

目的 ：应用目标设定理论促进2型糖尿病患者行为的改变。方法 ：将95位住院患者分为实验组（48例）和对照组（47例）,对照组采用常规护理教育,实验组采用目标设定策略进行干预,观察其在血糖、糖化血红蛋白、自护行为以及自我效能等方面的差异。结果 ：实验组在空腹血糖、餐后2h血糖、糖化血红蛋白及自我效能等方面的改变与对照组之间存在统计学差异（P〈0.05）;在饮食、血糖监测和足部护理等自护行为方面,实验组的改善情况也比对照组明显（P〈0.05）。结论：在糖尿病教育实践中,目标设定是一种有效、可行的行为改变策略。     

The patient''s experience of diabetes and its treatment: construction of an attitude scale by a semantic differential technique

An instrument for measuring attitudes towards diabetes and self-care was constructed by a semantic differential technique. The instrument contained nine adjective pairs. Factor analysis classified these into four factors: self-esteem/autonomy, object evaluation, quality of life supporting factor and self-strength/vulnerability. The reliability coefficient of test-retest by 28 nurses/nurse tutors was 0.93. Fifty diabetic patients completed the attitude scale for testing the validity of the instrument. Male patients had a more positive attitude towards diabetes than females. Those who had had diabetes for less than 10 years were more positive than those with a longer duration of the disease. A higher degree of education, well-performed self-monitoring of blood glucose and achievement of good metabolic control were all associated with a more negative attitude towards diabetes. A group of nurses/nurse tutors who also completed the attitude scale had a more negative attitude towards diabetes than the investigated groups of patients.     

Effect of Culturally Tailored Diabetes Education in Ethnic Minorities With Type 2 Diabetes: A Meta-analysis

BACKGROUND:: Diabetes is a major cause of cardiovascular morbidity and mortality. Ethnic minorities experience a disproportionate burden of diabetes; however, few studies have critically analyzed the effectiveness of a culturally tailored diabetes intervention for these minorities. OBJECTIVE:: The aim of this study was to evaluate the effectiveness of a culturally tailored diabetes educational intervention (CTDEI) on glycemic control in ethnic minorities with type 2 diabetes. METHOD:: We searched databases within PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycINFO, and ProQuest for randomized controlled trials (RCTs). We performed a meta-analysis for the effect of diabetes educational intervention on glycemic control using glycosylated hemoglobin (HbA1c) value in ethnic minority groups with type 2 diabetes. We calculated the effect size (ES) with HbA1c change from baseline to follow-up between control and treatment groups. RESULTS:: The 12 studies yielded 1495 participants with a mean age of 63.6 years and a mean of 68% female participants. Most studies (84%) used either group education sessions or a combination of group sessions and individual patient counseling. The duration of interventions ranged from 1 session to 12 months. The pooled ES of glycemic control in RCTs with CTDEI was -0.29 (95% confidence interval, -0.46 to -0.13) at last follow-up, indicating that ethnic minorities benefit more from CTDEI when compared with the usual care. The effect of intervention was greatest and significant when HbA1c level was measured at 6 months (ES, -0.41; 95% confidence interval, -0.61 to -0.21). The ES also differed by each participant's baseline HbA1c level, with lower baseline levels associated with higher ESs. CONCLUSIONS:: Based on this meta-analysis, CTDEI is effective for improving glycemic control among ethnic minorities. The magnitude of effect varies based on the settings of intervention, baseline HbA1c level, and time of HbA1c measurement. More rigorous RCTs that examine tailored diabetes education, ethnically matched educators, and more diverse ethnic minority groups are needed to reduce health disparities in diabetes care.     

Metabolic Control of Adults With Type 2 Diabetes Mellitus Through Education and Counseling

PURPOSE: To test the efficacy of a controlled nursing intervention focused on education and counseling to improve metabolic control of adults diagnosed with diabetes mellitus type 2 in (DMT2) ambulatory care. DESIGN: A quasi-experimental design with repeated measures was selected. A sample of 45 subjects participated, of which 25 were in the experimental group, and 20 in the comparison group. Measures were taken at 0, 3, 6, 9, and 12 months, including glycosylated hemoglobin (HbAlc), psychosocial, and clinical variables. FINDINGS: Results showed a significant decrease in HbAlc in the experimental group, as well as positive effects of self-care agency, adaptation, and barriers to treatment (plus one interaction) on the HbA1c levels and on the scores of self-care actions. CONCLUSIONS: The counseling and educational model applied in the intervention was effective to improve the metabolic control of diabetic patients in the experimental group. Self-care agency, adaptation, and barriers were predictors of self-care measures and level of HbA1c.     

A feasibility study of a culturally tailored diabetes intervention for Mexican Americans

Latinos, the fastest growing minority group in the United States, are among the hardest hit by diabetes. Among Latinos, Mexican Americans have the highest rate (23.9%) of diabetes. Good self-management can improve glycemic control and decrease diabetes complications but can be challenging to achieve. The purpose of this study was to test the feasibility and examine the effects of a culturally tailored intervention for Mexican Americans with type 2 diabetes on outcomes of self-management. The study used a pretest/posttest control group design with 10 participants in each group (N = 17). Feasibility and acceptability of the tailored diabetes self-management program was assessed by examining ease of recruitment and retention rates. The behavioral outcomes of self-efficacy, diabetes knowledge and self-care measures, and the biologic outcomes of weight, body mass index, HbA1C, and blood glucose were used to examine intervention effectiveness. Successful recruitment of participants came from personal referrals from providers or the promotora. Retention rates were 100% for the intervention group and 80% for the control group. Findings suggest that the intervention had a positive clinical and statistical effect on diabetes knowledge, weight, and body mass index. Improvements were also noted in self-efficacy scores, blood glucose, and HbA1C, but these changes did not reach statistical significance. A culturally tailored diabetes self-management program may result in improved outcomes for Mexican Americans with type 2 diabetes.     

Children’s Attitudes Toward Their Diabetes,Locus of Control,and HbA1c Levels

Children’s health attitudes and whether they are able to exert control over their chronic illness is related to disease management. For the current study, we assessed illness representations, general attitude toward having diabetes and health locus of control for 65 children with Type 1 Diabetes Mellitus (T1DM) and how these were related to parent report of child HbA1c levels. Results of our regression model indicated that internal locus of control moderated the relationship between illness attitude and HbA1c levels. Specifically, children with a high internal locus of control had lower (better) HbA1c levels. Additionally, children with a low internal locus of control for their diabetes and positive attitudes demonstrated lower HbA1c levels, whereas children with a low internal locus of control and negative attitudes had higher HbA1c levels. The generalizability of study findings is limited because the sample was mostly Caucasian youth reporting a fairly high locus of control. Future research is needed to determine whether changes in children’s perceptions of control over illness correspond to long-term improvements in health outcomes.     

Effectiveness of 1‐day trauma‐informed care training programme on attitudes in psychiatric hospitals: A pre–post study

Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma‐informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow‐up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre–post design with 3‐month follow‐up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1‐day programme consisting of a 3.5‐hour lecture and 1‐hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma‐Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma‐Informed Care scale scores increased significantly from 5.1 during pre‐training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3–0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2–0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3‐month follow‐up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.