The Science of Diabetes Self-Management and Care

Purpose

Community-based diabetes screening is common, but its impact on health outcomes is unclear. Screening protocols may not be standardized nor reflect current clinical practice. A community and clinical team examined the quality and consistency of community-based screening to diagnose hyperglycemic states, and it developed a bilingual screening tool to allow screeners to present accurate, actionable results to participants.

Methods

The team interviewed providers and community members, analyzed forms and educational materials utilized by screeners, and observed local diabetes screening events. Researchers compared glucose parameters used by screeners to published guidelines and observed finger-stick techniques and protocols for education, referral, and follow-up. Screening was divided into 3 phases: participant assessment before testing, obtainment of a sample, and interpretation of and counsel about results.

Results

There was a general lack of consistency in diabetes screening practices at the 12 screenings attended and among the 11 screeners interviewed. Assessment rarely included evaluation of diabetes risk factors or recent caloric intake. Obtaining a sample through fingersticks often included practices known to cause discomfort and decrease accuracy of glucose measurements. Criteria used to categorize results as “normal” or “abnormal” rarely followed published guidelines for laboratory-measured glucose values and varied significantly between screeners. No organization mentioned prediabetes in screenings. Postscreening consultation protocols varied widely.

Conclusions

Inconsistencies and inaccuracies in screening practices may limit the quality and relevance of community-based diabetes screenings. The impact of local screenings may be enhanced by using a tool that includes concrete steps and precise guidelines.

Purpose

The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults.

Methods

Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected.

Results

Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes.

Conclusions

African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

Purpose

The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D).

Methods

Using a mental model approach, a panel of experts— representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health—was convened to discuss reproductive health issues for female adolescents with T2D.

Results

Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one’s lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management.

Conclusions

Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.

Purpose

The purpose of this study was to use a community-based participatory research (CBPR) approach to translate the original Diabetes Prevention Program (DPP) to be age and culturally specific for American Indian (AI) youth.

Methods

Tribally enrolled members on 2 Montana Indian reservations conducted focus groups and interviews to discuss community members’ perspectives of factors that encouraged or were barriers to healthy diet and exercise behaviors in AI youth. In total, 31 community members, aged 10 to 68 years old, participated in 4 focus groups and 14 individual interviews. Participants were self-identified as elder, cultural expert, tribal health worker, educator, parent/guardian, youth, or school food service worker. Researchers analyzed transcripts based on inductive methods of grounded theory.

Results

Data analysis revealed translating the DPP to youth was contingent on the lessons incorporating cultural strategies for healthy behaviors in youth such as berry picking, gardening, horseback riding, and dancing; improving knowledge and access to healthy foods and physical activity for youth and their parents; having interactive, hands-on learning activities for healthy lifestyles in the DPP lessons; using a group format and tribal members to deliver the DPP lessons; and having tribal elders talk to youth about the importance of adopting healthy behaviors when they are young.

Conclusions

A CBPR approach engaged community members to identify strategies inherent in their culture, tradition, and environment that could effectively translate the DPP to Montana Indian youth living in rural reservation communities.

Purpose

This review appraised research evidence on the effectiveness of group visits for persons with diabetes. The group visit approach included both education and medical management of the patient, and this review focuses on the implications for the certified diabetes educator (CDE) as part of the group visit provider team.

Methods

A search of a comprehensive list of databases produced 395 articles related to group visits, group education, and primary care of patients with diabetes.

Results

Using specific inclusion criteria, 12 articles were included in the review. Four review articles examined a total of 75 studies, and 8 additional original research articles analyzed outcomes related to group visits in the care of patients with diabetes.

Conclusions

Current models for diabetes focused group visits that incorporate both group education and a health provider office visit in lieu of the traditional brief office visit failed to demonstrate consistent statistical improvement in A1C, BP, or lipids. There is evidence that group visits may reduce costs, some physiological outcomes may be improved, and patient and clinician satisfaction may be enhanced. The diabetes focused group visit model needs further testing by health care teams in a variety of settings including private primary care and rural practices.

Purpose

To explore the relationship between the symptoms of schizophrenia experienced by older persons diagnosed with schizophrenia and type 2 diabetes mellitus and their response to a health promoting intervention.

Methods

Secondary data analysis of data obtained from a lifestyle intervention program that recruited participants over age 40 with schizophrenia or schizoaffective disorder and type 2 diabetes mellitus from board-and-care facilities and day treatment programs. Participants had been randomly assigned to a 24-week diabetes awareness and rehabilitation training (DART; n = 32) or a usual care plus information (UCI; n = 32) comparison group. Baseline and 6-month (intervention completion) assessments included a diabetes knowledge test (DKT), diabetes self-efficacy measured by the diabetes empowerment scale (DES), and symptomatology defined by the Positive and Negative Syndrome Scale (PANSS). Simple linear regression models in 3 steps were used to analyze the data.

Results

A significant condition by symptom interaction was found for DKT. The difference between change in knowledge for DART and UCI groups depended on the prevalence and severity of the total, negative, and general symptoms. There was no significant condition by positive symptom interaction for DKT. A significant main effect was found between total, negative, positive, and general symptoms in the total sample for improvement in DES scores. Higher prevalence and severity of symptoms was negatively associated with improvement in DES scores.

Conclusion

Researchers need to consider the impact of schizophrenia symptoms in response to health promoting interventions.

Purpose

Recent research suggests that hearing loss, a frequent problem for aging adults, is more prevalent in people with diabetes. Hearing impairment affects a patient’s learning. This article reviews the anatomy and physiology involved in hearing, describes common causes of hearing loss in people with diabetes, and describes how hearing loss is diagnosed and treated. Two simple tests the diabetes educator can use to screen for hearing loss are described, and interventions that improve communication with patients with difficulty hearing are explained.

Conclusions

Hearing loss can negatively affect a patient’s ability to actively participate in diabetes education. Diabetes educators have a responsibility to learn how to communicate better with their patients who have a hearing impairment. Diabetes educators are uniquely positioned to improve the health status of their patients by identifying persons who need referral for further evaluation of their hearing.

Purpose

The purpose of this study was to describe firsthand experiences with yoga as shared by adults with or at risk for type 2 diabetes and to examine their beliefs regarding maintenance of yoga practice over time.

Methods

In this qualitative study, 13 adults with or at risk for type 2 diabetes described their experiences with yoga and their beliefs regarding maintenance of yoga practice over time. Semistructured interviews occurred 16 to 20 months after completion of an 8-week yoga-based clinical trial.

Results

Themes of readiness for continuing yoga, environmental support for yoga, and integrating yoga emerged through data analysis.

Conclusions

Findings indicate that yoga is appealing to some individuals with diabetes, but maintaining yoga practice over time is a challenge. Diabetes educators may be able to support maintenance by discussing specific strategies with individuals who express interest in yoga practice.