The Science of Diabetes Self-Management and Care

Purpose

Diabetes mellitus is a disease with debilitating potential. Growing numbers of elderly individuals are being admitted to under-resourced nursing homes with this often complicated, time-intensive, and costly diagnosis. The purpose of this systematic review of the literature was to determine the trends in diabetes management in nursing homes over the last decade including the use of clinical practice guidelines and the evaluation of management outcomes.

Methods

Ten medical, nursing, psychological, legal, and business databases were searched for articles written in English between 2000 and 2010 addressing diabetes management in nursing homes or long-term care settings. They were analyzed to determine diabetes management characteristics, use of clinical practice guidelines, resident outcomes associated with different regimens, and implications for improved management and outcomes.

Results

A total of 20 studies from 6 countries, primarily the United States, including both qualitative and quantitative designs and a combined sample of 779 707 residents, met the inclusion criteria. The majority of the studies described frequencies of various management practices and found rare clinical practice guideline adherence.

Conclusion

A severe lack of research relating management practices to health and quality-of-life outcomes was evident as was a lack of the voice of the resident in determining the diabetes regimen. Clear implications were found for improvement in diabetes management education for residents, families, and all health care providers in this setting.

Objective

The purpose of this study was to gain insight into the current diabetes management practices of endurance athletes with type 1 diabetes and to compare these practices with the guidelines for athletes established by the American Diabetes Association (ADA).

Methods

Participants included in this descriptive study were endurance athletes aged 18 years and older with type 1 diabetes. The survey questions were based on the current clinical recommendations for endurance athletes with type 1 diabetes, as established by the ADA. A link to the questionnaire was posted on the Web site of the Diabetes Exercise and Sports Association (DESA). A total of 38 questions were included in the survey, and 91 usable surveys were received. Analysis of variance was used for several comparisons using SPSS version 17.

Results

Half of the clinical guidelines were followed by the participants. Among these, about 50% followed many of the guidelines “most of the time” or “almost always” and 40% followed the guidelines “sometimes” or “most of the time.” Results of ANOVA showed several trends (nonsignificant) in the occurrence of low blood glucose when the guidelines were not followed.

Conclusion

Endurance athletes with type 1 diabetes do not consistently follow the clinical guidelines for blood glucose management as recommended by the ADA. The results of this study reflect a need among athletes for diabetes management education programs that promote a better understanding of the potential negative side effects of suboptimal blood glucose control.

Purpose

The purpose of this study was to explore the issues and challenges faced by certified diabetes educator (CDE) trainees in providing diabetes self-management education to patients in safety-net practices.

Methods

Semi-structured interviews were conducted with CDE trainees and a CDE mentor in 2 primary care practices. Transcripts were analyzed using a content-driven immersioncrystallization approach to identify major themes.

Results

Four major themes emerged from the qualitative interview data: (1) patient recruitment approaches, (2) patient barriers to attending diabetes education classes, (3) teaching challenges, and (4) CDE integration into the practices.

Conclusions

This study underscores the need for diabetes educators and other health education professionals to be creative and flexible in delivering self-management education to patients in underserved settings. The complexity of diabetes care and the self-care responsibilities placed on the patient reinforce the need for a team approach such as that proposed in the medical home model and should include certified diabetes educators.

Purpose

The purpose of the present study was to describe the dietary intake of vitamin D in an urban, low income, predominantly African American sample of adolescents with insulin dependent diabetes.

Methods

Participants were 99 adolescents diagnosed with insulin dependent diabetes. Vitamin D intake was estimated from dietary recall data. Blood glucose levels were also assessed.

Results

The average daily vitamin D intake estimated from dietary recall data was 102 IUs (SD = 64.4) with 70% of adolescents consuming less than 50 IUs of vitamin D in their day. Level of vitamin D intake was a significant predictor of HbA1c levels in the current sample.

Conclusions

Results indicate a need for the assessment of vitamin D levels in this at-risk population, as supplementation may be indicated.

Purpose

This study explores the potential utility of a culturally tailored diabetes management intervention approach by testing associations between acculturation and diabetes-related beliefs among Mexican-American adults with type 2 diabetes.

Methods

Data from 288 Mexican-American adults with type 2 diabetes were obtained via a bilingual, telephone-administered survey. Participants were drawn from a stratified, random sample designed to obtain maximum variability in acculturation. The survey assessed diabetes-related beliefs, intervention preferences, and the following three acculturation constructs from the Hazuda acculturation and assimilation scales: Spanish use, value for preserving Mexican culture, and interaction with Mexican Americans.

Results

Only one outcome—preference for a program for Mexican Americans—was associated with all three acculturation variables. Spanish use was positively associated with belief in susto as a cause of diabetes, preference for expert-driven health guidance, and involvement of others in taking care of diabetes. Value for preserving Mexican culture was related to a more holistic view of health, as evidenced by an increased likelihood of consulting a curandero, use of prayer, and interest in a diabetes program with religious content. Value for cultural preservation was also related to higher suspicion of free diabetes programs. Interaction with Mexican Americans was associated with a belief that insulin causes blindness.

Conclusion

Findings from this study suggest distinct relationships between acculturation constructs and diabetes-related beliefs and preferences, thus arguing against the use of a single acculturation construct to determine diabetes intervention design. Cultural tailoring may enhance the cultural appropriateness and ultimate effectiveness of diabetes interventions for Mexican American adults.

Purpose

The purpose of this study was to assess dietary intake habits of Mexican American Hispanic adults participating in the En Balance diabetes education program.

Methods

En Balance is a 3-month culturally sensitive diabetes education intervention for Spanish-speaking Hispanics. Of the 46 participants enrolled, 39 mainly Mexican American Hispanic adults with type 2 diabetes completed the En Balance program. Participants lived in the Riverside and San Bernardino counties of California, and all participants completed the program by June 2008. Dietary intake was assessed at baseline and at 3 months using the validated Southwest Food Frequency Questionnaire.

Results

Clinically important decreases in glycemic control and serum lipid levels were observed at the end of the 3-month program. The baseline diet was characterized by a high intake of energy (2478 ± 1140 kcal), total fat (87 ± 44 g/day), saturated fat (28 ± 15 g/day), dietary cholesterol (338 ± 217 mg/day), and sodium (4236 ± 2055 mg/ day). At 3 months, the En Balance group mean intake of dietary fat (P = .045) and dietary cholesterol ( P = .033) decreased significantly. Low dietary intakes of docosahexaenoic acid, eicosapentaenoic acid, and vitamin E were also observed in these adults with type 2 diabetes.

Conclusions

The En Balance program improved glycemic control and lipid profiles in a group of Hispanic diabetic participants. En Balance also promoted decreases in dietary fat and dietary cholesterol intake.

Purpose

The purpose of this study was to examine differences in diabetes self-care and provider-based quality-of-care indicators between rural and urban dwellers in a nationally representative sample of adults with diabetes.

Methods

Data were analyzed on 52 817 individuals with type 2 diabetes from the 2007 Behavioral Risk Factor Surveillance Survey. Rural and urban residence was based on metropolitan statistical area. Self-care behaviors (nutrition, physical activity, self-monitoring) and quality-of-care indicators (clinical visits, glycemic control, preventive measures) were self-reported. Logistic regression analyses were done using STATA 10 to assess the independent effect of rural/urban residence on self-care and each quality measure and to account for the complex survey design.

Results

Rural residents comprised 21% of the sample and were less likely to receive diabetes education (57% vs 51%, P < .001). The final adjusted model showed that foot self-checks (odds ratio, 1.42; 95% confidence interval, 1.27-1.59) and blood glucose testing at least once daily (odds ratio, 1.14; 95% confidence interval, 1.02-1.26) were significantly higher among rural individuals. Provider-based quality of care was not significantly different by rural/urban residence.

Conclusion

Contrary to what has been reported, there were no significant differences in diabetes quality of care between rural and urban dwellers. In addition, rural dwellers appeared to have better self-care behaviors than urban dwellers. Further research is needed to clarify the reasons for these findings.

Purpose

The translation of an evidence-based lifestyle intervention to an online delivery format has the potential to provide an effective treatment option for obesity in primary care practice. Research is needed, however, to standardize e-counseling procedures to promote the training of health coaches and the dissemination to primary care settings. This article describes the development of an online lifestyle intervention coaching protocol adapted from the Diabetes Prevention Program lifestyle intervention curriculum.

Conclusions

The delivery of patient counseling via the Internet may enable the dissemination of high-quality lifestyle advice to prevent diabetes in patients whose schedules or geographic constraints prohibit their participation in in-person counseling sessions.