The Science of Diabetes Self-Management and Care

There is very little reported information concerning the participation of older adults in diabetes education and care programs, factors related to their attendance, and the influence of attendance on program outcomes. In this study, which was part of a larger study of insulin therapy, subjects (≥65 years old) assigned to the intensive management group (n=53) were provided with educational sessions during the 18-month study period. Data for this group were examined to determine factors that influenced enrollment and attendance. Attendance rates for individual participants averaged 72% during the first 6 months months and 68% during the subsequent 12 months. Demographic factors. baseline knowledge test scores, and baseline glycosylated hemoglobin levels did not significantly influence participation. Greater distance from the clinic and shorter time using insulin were significantly related (P=.05) to attendance. Perceived benefits of the program included diabetes education (45%), glucose control (23%), and interacting with others who have diabetes (23%).

This exploratory study was undertaken to describe the differences in the greatest fears about having diabetes between type 1 and type 2 patients. Frequency distributions. measures of central tendency, and nonparametric statistics were employed to examine the traits of the sample and to make comparisons between type 1 and type 2 patients. Content analysis was used to describe and analyze the subjects' responses to the question, What is your greatest fear about having diabetes? Subjects' answers to this question were categorized and scored as representing fear of either a long-term or acute complication based on the clinical judgment of the authors. Results revealed that both type 1 and type 2 patients were likely to have given responses that were suggestive of fear of long-term complications. The major fears concerned amputation, cardiovascular diesease, nephropathy, neuropathy, retinopathy, and stroke. The findings of the present investigation suggest that diabetes educators may need to address patients' fears of long-term complications directly and effectively. Several areas of research that grew out of this exploratory study were recommended for future consideration.

Diabetes self-management is a challenging task due to its complexity and ever-present barriers to self-care. A key issue for patients, providers, and healthcare systems is how to deliver personalized behavioral support in ways that are affordable and can reach most patients. The Internet offers several advantages in this regard because it is available 24 hours a day, low cost, and capable of reaching thousands of patients. Although Internet sites for diabetes support are popular, they have not been evaluated. For this study, a Web site for diabetes self-management that emphasized personalized goal setting, feedback, and social support was developed. Over a 10-week period, 111 different persons logged onto D-NET for a total of 21 046 accesses. Users included persons across a broad age range (up to age 77 years) and duration of diabetes. The most popular areas of the site were the Social Support Conference and the Diabetes Information Pages. User ratings revealed high satisfaction with the service. The Internet has great potential for providing needed support and services for patients with diabetes and other chronic illnesses.

Many chronic diseases that are leading causes of morbidity and mortality can be prevented or controlled by primary or secondary interventions. Type 2 diabetes with its complications constitutes a major health problem, especially among Mexican Americans. The purpose of this pilot study was to develop an age- and culturally appropriate primary intervention program for Mexican American children at risk of type 2 diabetes. The sample included 37 Mexican American children ages 7 to 12 years who had at least one parent or grandparent with type 2 diabetes. A health screen of physiologic risk factors, a nutritional assessment, and a diabetes knowledge test were administered before and after the program. The eight-session activity oriented educational program focused on nutrition, exercise, and diabetes knowledge. Due to small sample size and limited study time, changes in physiologic factors and diet were not analyzed for statistical significance. Analysis of individual factors showed a trend toward more normal values. Results of this pilot program indicated that health intervention projects may be effective in helping children at risk of type 2 diabetes adopt healthier lifestyles.

Type 2 diabetes is extremely common and increasing in the United States. The pathophysiology of type 2 diabetes is a combination of increased insulin resistance and inadequate secretion. The main risk factors for diabetes are family history. obesity, sedentary lifestyle, ethnic background, age, and a history of gestational diabetes. Diet and exercise, the cornerstones of diabetes management, will improve insulin sensitivity and indirectly augment insulin secretion. Until recently, the only pharmacological approaches to diabetes were sulfonylureas and insulin, which either augment insulin secretion or replace insulin, thus acting only on the insulin side of the equation. Recently, a series of new drugs have become anailable that are capable of decreasing hepatic glucose output (metformin), slowing postprandial glucose absorption (acarbose), and improving peripheral insulin sensitivity (troglitazone). With these drugs, either alone or in combination, and behavioral therapies, it is now feasible to achieve good to outstanding glycemic control in most individuals with type 2 diabetes.