Pre-conception diabetes care in insulin-dependent diabetes mellitus.

Prospective studies of pre-conception diabetes care have confirmed its positive impact on the incidence of malformations by improving glycaemic control. Less information is available on the impact of pre-conception care on maternal and neonatal morbidity. This audit addresses its impact on timing and mode of delivery, incidence of macrosomia and rate of admission to neonatal unit care in addition to sociodemographic factors which may influence attendance at such a service. Attenders were more likely to be in a stable relationship and be non-smokers. They were more likely to book for antenatal care earlier and with a lower glycated haemoglobin. There were no early deliveries (i.e. < 30 weeks) or small for gestational age (SGA) babies in those who attended for pre-conception care and no neonatal deaths. Admission to NNU care was reduced by 50% in those who attended for pre-conception care. Although the rate of macrosomia was reduced, there was no impact on the Caesarian section rate. A pre-conception diabetes clinic may have a positive impact on neonatal morbidity.     

Preconception care of women with diabetes

Preconception care in women with diabetes reduces the risk of spontaneous abortion and congenital malformations as a result of improved glycemic control before and during organogenesis. Prepregnancy planning encompasses optimizing glycemic control and also affording the opportunity for genetic counseling, contraceptive selection, management of diabetes complications, and evaluation of psychosocial aspects of pregnancy, childbearing, and diabetes care. The purpose of this article is to provide nurses with current clinical assessment and management strategies of women with diabetes in order to implement a comprehensive individualized preconception plan of care.     

Improving the care of women with gestational diabetes

The article reviews gestational diabetes mellitus, including etiology, diagnostic and screening criteria, risk factors, and care of the affected woman. Gestational diabetes mellitus affects approximately 7% of all pregnant women, resulting in more than 200,000 cases each year, and is defined as glucose intolerance that begins or is first recognized during pregnancy. Women are considered at high risk for gestational diabetes if they are markedly obese, have a personal history of gestational diabetes, have a strong family history of diabetes, or have glycosuria. Risk assessment is essential in determining whether a woman should be screened or tested for gestational diabetes. Women who have had gestational diabetes should have comprehensive preconception care prior to a subsequent pregnancy to ascertain appropriate weight, nutrition, exercise, and signs of gestational diabetes.     

Primary care cancer and diabetes complications screening of black women with type 2 diabetes

PURPOSE: To determine the frequency with which Black women with type 2 diabetes receive routine primary health care screening for cancer and diabetes complications. DATA SOURCES: Pilot study data from a convenience sample of 21 Black women (mean age 46.8 years) with type 2 diabetes. CONCLUSIONS: Cancer screening consisted of Pap smear, mammography, and colon cancer screening consistent with current American Cancer Society recommendations. Ninety percent reported having had a Pap smear, 86% mammogram and 33% colon cancer screening. Diabetes complications screening was based on the American Diabetes Association care recommendations. Fifty-five percent received screening eye exams, 40% were screened for renal proteinuria, and 50% received foot examinations and diabetes foot care instruction. IMPLICATIONS FOR PRACTICE: This sample of mid-life, Black, educated, working women with type 2 diabetes utilize healthcare services and have high rates of primary care cancer screening. Rates of diabetes complications screening are less than optimal. Because Black American women suffer disproportionately high rates of diabetes and related complications, it is imperative that they receive quality diabetes care in an effort to improve health outcomes and decrease premature mortality.     

Prepregnancy care and pregnancy outcomes in women with type 1 diabetes

OBJECTIVE: The objective of this study was to examine the relationship between prepregnancy care, glycemic control, maternal hypoglycemia, and pregnancy outcomes in women with type 1 diabetes. RESEARCH DESIGN AND METHODS: This was a prospective observational cohort study of women with type 1 diabetes who delivered from 1991 to 2002. Outcome measures were attendance at a clinic for prepregnancy care, maternal HbA(1c) (A1C) throughout pregnancy, maternal severe hypoglycemic episodes, macrosomia, preeclampsia, premature delivery (delivery before 37 weeks), very premature delivery (delivery before 34 weeks), spontaneous abortion, and adverse pregnancy outcome (defined as major malformation, stillbirth, and neonatal death). RESULTS: There were 290 pregnancies, in which 110 (38%) women had prepregnancy care. The prepregnancy care group contained more primiparous women (54.7 vs. 40.6%; P = 0.021) and fewer smokers (9.4 vs. 28.7%; P < 0.0001). They registered earlier (6.6 vs. 8.3 weeks, P < 0.0001) and had a lower A1C at the initial visit (6.5% vs. 7.6%; P < 0.0001). Adverse pregnancy outcomes and very premature deliveries were significantly lower in women who received prepregnancy care (2.9 vs. 10.2%; P = 0.03 and 5.0 vs. 14.2%; P = 0.02, respectively). In contrast, between groups, there was no difference in A1C after 24 weeks or in the rates of macrosomia, preeclampsia, or maternal severe hypoglycemic episodes. CONCLUSIONS: Prepregnancy care was associated with improved glycemic control in early pregnancy and significant reductions in adverse pregnancy outcome (malformation, stillbirth, and neonatal death) and very premature delivery. However, prepregnancy care failed to have an impact on glycemic control in later pregnancy or to reduce the risk of macrosomia and preeclampsia.     

同伴互动支持模式在糖尿病患者自我管理中的应用

目的比较护士护理管理模式（NCM）与同伴互动支持模式（RPS）在糖尿病患者自我管理中的作用。方法选取174名2型糖尿病患者（糖化血红蛋白HbA1c大于等于7．5％）,随机分为NCM组和RPS组进行对照试验。比较两组6个月后的糖化血红蛋白（HbA1c）水平,胰岛素治疗方案,血压、口服药物依从性、糖尿病抑郁评分等。结果RPS组平均糖化血红蛋白由8．02％下降至7．73％,而NCM组从7．93％上升至8．22％。两组糖化血红蛋白的变化比较差异具有统计学意义（t=2．732,P〈0．05）。RPS组8例开始胰岛素治疗,NCM组1例（P〈0．05）。两组血压、药物依从性、糖尿病抑郁分数评分差异无统计学意义（P〉0．05）。结论同伴互动支持模式可以作为糖尿病患者自我管理的有效模式。     

Providing diabetes self-management support in rural primary care clinics with nurse partners

This study examined the roles and effectiveness of nurse partner-provided diabetes self-management (DSM) support in five rural primary care clinics. There were two to nine providers and one nurse partner in each clinic; nurses were licensed practical nurses (LPNs) in all but one clinic. Interviews with providers and observations of patient interactions assessed nurse roles, clinic processes, and communication patterns. Using immersion-crystallization methods, three major themes explained nurse partner role variation: "gatekeeper" role of providers, compression of time and space within clinic work flow, and nurses' educational background and experience. While nurses' education and experience were important, clinics where providers facilitated nurse participation in DSM support through focused communication and commitment of time and space most effectively integrated DSM support into their practice. Some quantitative measures improved; notably glycated hemoglobin level and patients' frequency of blood glucose measurement. Study findings provide guidance on using nurses in primary care clinics to provide DSM.     

The role of peer support in diabetes care and self-management

In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.     

A culturally competent intervention of education and care for black women with type 2 diabetes.

This article reports on the development and pilot feasibility testing of a culturally competent intervention of education and care for black women with type 2 diabetes mellitus (T2DM). Using a one group, pretest posttest quasi-experimental design, the intervention was tested with a convenience sample of 25 community black women with T2DM. The conceptual basis, process, and content of the intervention as well as the feasibility and acceptability of study materials and methods are described. Significant improvements from baseline to 3 months were observed in measures of glycemic control, weight, body mass index, and diabetes-related emotional distress. The findings suggest that a culturally sensitive intervention of nurse practitioner diabetes care and education is beneficial for black women with T2DM, resulting in program attendance, kept appointments, improved glycemic control and weight, and decreased diabetes-related emotional distress.     

The knowledge of women with diabetes mellitus regarding preconception care and maternal-fetal risks

The objective of this study was to describe the reproductive profile of women with diabetes mellitus (DM) and to identify their knowledge regarding maternal and fetal risks and preconception care. This exploratory study was performed at the Integrated Center for Hypertension and Diabetes, from March to July 2009, on a sample consisting of 106 women. The variables were: number of pregnancies, births and abortions, and planning the pregnancy. The data were collected through interviews that followed a preconceived form. The reproductive profile of women with DM proved to be permeated with risks and showed negative repercussions to maternal and fetal health. Of the 106 (100%) women studied, 44 (41.5%) demonstrated adequate knowledge regarding preconception care, while 58 (54.7%) had limited knowledge regarding maternal and fetal risks. It is necessary to provide information to women with diabetes to promote knowledge of maternal and fetal risks and preconceptional care.     

Wound care for persons with diabetes

This article addresses local wound care in people with diabetes mellitus. An approach is proposed that uses wound depth and color to determine the goals of local wound treatment. Principles of cleansing, debridement, and the use of moisture retentive dressings are discussed. Infection, a significant problem in the diabetic patient, is addressed as an essential part of local wound care in these patients.     

Wound care for persons with diabetes

This article addresses local wound care in people with diabetes mellitus. An approach is proposed that uses wound depth and color to determine the goals of local wound treatment. Principles of cleansing, debridement, and the use of moisture retentive dressings are discussed. Infection, a significant problem in the patient with diabetes, is addressed as an essential part of local wound care in these patients.     

产科临床护理路径在妊娠期糖尿病孕妇中的应用效果

目的：探讨产科临床护理路径对妊娠期糖尿病孕妇的实施效果。方法选择妊娠期糖尿病孕妇80例,按照随机数字表法分为观察组和对照组各40例,观察组采用产科临床护理路径实施护理指导和管理,对照组则采用常规产科护理方法,比较两组孕妇健康教育达标、出院回访率与满意度、分娩方式、产后出血、母乳喂养、血糖控制等差异。结果观察组患者空腹血糖为（4．61±0．43）mmol/L,餐前30 min血糖为（4．21±0．89） mmol/L,餐后2 h 血糖为（6．22±0．21） mmol/L,凌晨血糖为（4．92±0．73）mmol/L,对照组分别为（5．72±3．20）,（5．85±2．42）,（7．68±2．95）,（6．39±3．18）mmol/L,差异有统计学意义（t 值分别为2．1743,4．0226,3．1222,2．8495;P ＜0．05）。观察组剖宫产者13例（32．50％）,对照组剖宫产者24例（60．00％）,差异无统计学意义（χ2＝2．2052,P＞0．05）。观察组产后出血者2例（5．00％）,母乳喂养者38例（95．00％）;对照组产后出血者12例（30．00％）,母乳喂养者29例（72．50％）,两组比较,差异有统计学意义（χ2值分别为8．6580,7．4397;P＜0．05）。观察组孕妇的依从性高于对照组,差异有统计学意义（ U＝2．9144,P＜0．01）;观察组孕妇健康教育达标率高于对照组,差异有统计学意义（χ2＝23．8095,P＜0．01）;观察组产后出院回访率高于对照组,差异有统计学意义（U＝2．8353,P＜0．01）。结论产科临床护理路径能明显提高糖尿病孕妇的血糖控制率,提高其满意度和依从性,具有较高的临床推广应用价值。     

糖尿病孕妇的护理干预

妊娠期糖代谢异常是产科常见的疾病,发病因素与胰岛素抵抗和妊娠期特有的激素分泌增加有关,如得不到及时诊治,会出现一系列母婴并发症,是危及母婴健康及导致围产儿死亡的重要原因之一,国内报道其发病率在6．4％。     

妊娠期糖尿病孕妇产后转归及保健情况调查

目的：了解妊娠期糖尿病（GDM）孕妇产后2年转归情况、保健现状和产后保健需求,为完善GDM孕妇产后保健、减少不良转归提供参考。方法：通过便利抽样对2年内在天津市某三级甲等医院产科分娩的妊娠期糖尿病孕妇产后转归现状及保健需求进行问卷调查。结果：13.6%GDM孕妇出现产后体质量滞留;56.5%GDM孕妇产后从未监测过血糖,4.2%GDM孕妇在产后不同时间出现了糖耐量受损,1例GDM孕妇产后2年内已确诊2型糖尿病;59.7%GDM孕妇在产后42天内进行了产后保健,34.6%GDM孕妇从未进行过产后保健,36.1%GDM孕妇没有得到任何相关专业人士的指导;GDM孕妇更希望由妇产科医生、助产士、社区保健医生通过孕妇学校课程、宣传手册、微信公众号等线上形式提供新生儿保健指导、膳食指导、运动指导、主要照护者健康教育等保健内容。结论：目前GDM孕妇对血糖变化重视程度较低,自我监测意识较差;产后保健不够系统、规范,未来应进一步加强筛查与管理,以减少GDM产后不良转归的发生。