Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2 / Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2 / Risk of unstable glycemia in elderly people with type 2 diabetes mellitus

Objetivo: avaliar os fatores de risco do diagnóstico de enfermagem Risco de glicemia instável em pessoas idosas com diabetes mellitus tipo 2. Método: estudo transversal realizado com 152 pessoas idosas atendidas na atenção primária de agosto a outubro de 2021. Na consulta de enfermagem, avaliaram-se dados clínicos, perda de sensibilidade protetora plantar e checklist com fatores de risco do Risco de glicemia instável da NANDA. Empregaram-se análise descritiva e testes de associação. Resultados: 46,7% apresentaram HbA1c ≥ 7,0 e maior prevalência dos fatores de risco: Conhecimento insuficiente sobre o controle da doença (p<0,001); Conhecimento insuficiente sobre os fatores modificáveis (p<0,001); Controle insuficiente do diabetes (p<0,001); Falta de adesão ao plano de controle do diabetes (p=0,002); e Monitorização inadequada da glicemia (p<0,001). Conclusão: os fatores de risco foram relacionados ao conhecimento insuficiente e à falta de manejo com a doença, ressaltando a importância do enfermeiro no planejamento de cuidados adequado.

Objective: to assess the risk factors of the nursing diagnosis Risk of unstable glycemia in elderly people with type 2 diabetes mellitus. Method: cross-sectional study carried out with 152 elderly people assisted in primary care from August to October 2021. In the nursing consultation, clinical data, loss of plantar protective sensitivity and a checklist with risk factors of unstable NANDA glycemia risk were evaluated. Descriptive analysis and association tests were used. Results: 46.7% had HbA1c ≥ 7.0 and higher prevalence of risk factors: Insufficient knowledge about disease control (p<0.001); Insufficient knowledge about modifiable factors (p<0.001); Insufficient control of diabetes (p<0.001); Lack of adherence to the diabetes control plan (p=0.002); and Inadequate blood glucose monitoring (p<0.001). Conclusion: risk factors were related to insufficient knowledge and lack of management with the disease, emphasizing the importance of nurses in the planning of appropriate care.

Objetivo: evaluar los factores de riesgo del diagnóstico de enfermería Riesgo de glucemia inestable en ancianos con diabetes mellitus tipo 2. Método: estudio transversal realizado con 152 ancianos atendidos en la atención primaria de agosto a octubre de 2021. En la enfermería consulta, se evaluaron datos clínicos, pérdida de sensibilidad protectora plantar y se utilizó la lista de verificación con factores de riesgo de NANDA Riesgo para glucemia inestable. Se utilizaron análisis descriptivos y pruebas de asociación. Resultados: 46,7% tenían HbA1c ≥ 7,0 y mayor prevalencia de factores de riesgo: Insuficiente conocimiento sobre control de la enfermedad (p<0,001); Conocimiento insuficiente sobre factores modificables (p<0,001); control insuficiente de la diabetes (p<0,001); Falta de adherencia al plan de control de la diabetes (p=0,002); y Monitoreo inadecuado de glucemia en sangre (p<0.001). Conclusión: los factores de riesgo se relacionaron con el conocimiento insuficiente y la falta de administración de la enfermedad, destacando la importancia de los enfermeros en la planificación de la atención adecuada.

A nurse-led, community-based self management program for people living with type 2 diabetes in Western Ethiopia: A feasibility and pilot study protocol.

AIM: To develop and examine the preliminary effects of a nurse-led, community-based diabetes self management education and support program on clinical outcomes, self care behaviours, quality of life and family support through a pilot randomized controlled trial among adults living with type 2 diabetes in Western Ethiopia. METHODS: A two-arm parallel-group pilot randomized controlled trial involving participant-caregiver dyads will be conducted. A total of 76 dyads will be recruited, with 38 dyads randomly allocated to the intervention arm receiving six sessions of the diabetes self management education and support program supported by an educational handbook, flier and video on top of the usual care; the control arm will continue to receive the usual care. The intervention will be guided by social cognitive theory and related international guidelines for diabetes management, addressing misconceptions, using culturally tailored foods and involving family members in the intervention. Participants will be recruited at Nekemte Specialized Hospital over 2 months. Nurses will deliver the intervention in the community in Nekemte, western Ethiopia. Diabetes self​ care behaviour, quality of life, family support, glycosylated haemoglobin, body mass index, blood pressure and lipid profiles will be assessed. Descriptive statistics will summarize the sociodemographic variables of the dyads; people living with diabetes' clinical outcomes, self care behaviours, quality of life and the level of family support; family caregivers' behaviours; and the acceptability level. Cohen's d will be computed to estimate the effect size. TRIAL REGISTRATION: The Chinese Clinical Trial Registry prospectively registered the trial, and the registration number was ChiCTR2000040292.

Organisational factors influencing non-pharmacological management of type 2 diabetes mellitus (T2DM) in public hospitals across Lagos, Nigeria: A qualitative study of nurses' perspectives.

BACKGROUND: The prevalence and incidence of Type 2 Diabetes mellitus (T2DM) are significantly increasing in Nigeria. Effective management of the condition, in clinical settings, can be achieved with a minimal financial cost, but this is often overlooked. It is crucial to understand organisational factors influencing non-pharmacological management of T2DM in Nigerian public hospitals for effective management of patients diagnosed with the condition. AIM: To examine healthcare delivery services influencing patient management and seek approaches to heighten optimisation of patient health outcomes. METHODS: Adopting a qualitative case study design, we used the Constant Comparative Method and semi-structured questions to interview17 nurses in public hospitals across Lagos. Using the five stages of the Framework Analysis process, the transcribed interviews were thematically analysed. RESULTS: Nurses suggested that a complex, multifaceted system constituted organisational factors influencing T2DM management in public hospitals across Lagos, Nigeria. Specific factors identified were levels of available information and knowledge, relationship, policy and decision-making management. These factors were, in turn, linked to political, infrastructural, health professional and the environments within which patients were given health services. CONCLUSIONS: The study revealed a significant gap in the organisation of care for individuals diagnosed with T2DM in public hospitals across Lagos. Timely and affordable strategies have been highlighted to secure effective care delivery to patients.

Eight-year post-trial follow-up of health care and long-term care costs of tele-based health coaching.

OBJECTIVE: To evaluate the long-term effect of telephone health coaching on health care and long-term care (LTC) costs in type 2 diabetes (T2D) and coronary artery disease (CAD) patients. DATA SOURCES/STUDY SETTING: Randomized controlled trial (RCT) data were linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year economic evaluation was conducted. STUDY DESIGN: A total of 1,535 patients (≥45 years) were randomized to the intervention (n = 1034) and control groups (n = 501). The intervention group received monthly telephone health coaching for 12 months. Usual health care and LTC were provided for both groups. PRINCIPAL FINDINGS: Intention-to-treat analysis showed no significant change in total health and long-term care costs (intervention effect €1248 [3 percent relative reduction], CI -6347 to 2217) in the intervention compared to the control group. There were also no significant changes among subgroups of patients with T2D or CAD. CONCLUSIONS: Health coaching had a nonsignificant effect on health care and long-term care costs in the 8-year follow-up among patients with T2D or CAD. More research is needed to study, which patient groups, at which state of the disease trajectory of T2D and cardiovascular disease, would best benefit from health coaching.

Nurse-led psychological intervention for type 2 diabetes: a cluster randomised controlled trial (Diabetes-6 study) in primary care.

BACKGROUND: Suboptimal glycaemic control in type 2 diabetes (T2D) is common and associated with psychological barriers. AIM: To investigate whether it was possible to train practice nurses in six psychological skills (Diabetes-6 [D6]) based on motivational interviewing (MI) and basic cognitive behaviour therapy (CBT), and whether integrating these with diabetes care was associated with improved glycaemic control over 18 months compared with standard care. DESIGN AND SETTING: Two-arm, single-blind, parallel cluster randomised controlled trial in primary care. METHOD: Adult participants (n = 334) with T2D and persistent HbA1c ≥69.4 mmol/mol were randomised to receive 12 sessions of either the D6 intervention or standard care over 12 months. Practice nurses were trained in the six psychological skills and their competencies were measured by standardised rating scales. Primary outcome was a change in HbA1c level at 18 months from randomisation. Secondary outcomes were changes in systolic and diastolic blood pressure, body mass index, waist circumference, depressive symptoms, harmful alcohol intake, diabetes-specific distress, and cost-effectiveness. RESULTS: Using intention-to-treat analysis, there was no significant difference between D6 intervention and standard care in HbA1c (mean difference -0.79 mmol/mol, 95% confidence interval [CI] = -5.75 to 4.18) or for any of the secondary outcomes. The competency level of D6 nurses was below the beginner proficiency level and similar to the standard-care nurses. CONCLUSION: Training nurses in MI and basic CBT to support self-management did not lead to improvements in glycaemic control or other secondary outcomes in people with T2D at 18 months. It was also unlikely to be cost-effective. Furthermore, the increased contact with standard-care nurses did not improve glycaemic control.

Burden changes in caregivers of patients with type 2 diabetes: A longitudinal study.

AIMS: The aim of this study was to explore changes in the burden of caregivers of patients with type 2 diabetes experiencing lower limb amputation after surgery. BACKGROUND: Literature suggests the burden overload experienced by the caregivers of new amputees is related to an imbalance between the demands and the resources available to these caregivers. DESIGN: The study followed a longitudinal design assessing caregiver burden at 1 (T1), 7 (T2) and 10 (T3) months after the patient's surgery. METHODS: We used a convenience sample of caregivers of patients with type 2 diabetes amputated with recent lower limb amputation. Data were collected in several hospital units over 18 months in 2014-2015. Sample size included at T1, T2 and T3 110, 101 and 84. Participants completed the socio-demographic questionnaire, the Burden Assessment Scale and the Self-Assessment Caregiver Questionnaire scale. RESULTS: Caregivers who received help reported lower levels of burden from at baseline with no variation over time. Those caregivers with high levels of stress showed an increase in burden over time, although these results were not significant. Also, caregivers who did not receive help showed higher levels of burden and stress over time compared with the initial baseline that decreased over time. CONCLUSION: These results highlight the importance of receiving help, in care, especially among caregivers who care for patients who have undergone major amputation.

Diabetes management in a foreign land: A case study on Chinese Australians.

The aim of this study was to understand the experience of Chinese migrants living with type 2 diabetes in Australia and explore their culturally specific diabetes management needs, habits and expectations in the Australian context to help shape an Australian Chinese diabetes service. A case study approach was employed across two Australian cities (Melbourne and Sydney), using participant-observations and qualitative interviews. Purposive sampling was used to find diabetes education sessions for observation and facilitators for interviews before snowball technique was used to identify relevant clinicians. Thematic analysis with pattern matching was used for data analysis. A total of 18 participant-observations and 12 interviews were conducted. Chinese migrants appeared to experience multiple barriers in accessing the Australian diabetes care service further complicated by the mismatch between the expectations of Chinese patients and the services available. Chinese patients were observed to be collectivistic-orientated relying on friends for diabetes management. While health professionals appeared to be perceived as a source of reputable health information, they often did not provide ongoing support. When professional support was limited, Chinese patients adopted alternative strategies to address their diabetes, which often involved seeking help and information from peers. Some of this information was non-reputable, potentially resulting in detrimental health outcomes. In conclusion, redesigning diabetes care services in line with the principles of collectivism may more appropriately match the Chinese migrants' expectations and needs, and better support them in their diabetes journey.

Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial.

BACKGROUND: Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. METHODS: MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. DISCUSSION: The MODERN trial will provide evidence for the potential benefit of independent nurse-run clinics in the community and their cost-effectiveness in adults with MetS. Findings will enable more nurse-led clinics to be adopted outside of major cities and encompassing other chronic diseases as a key primary preventative initiative. TRIAL REGISTRATION: MODERN is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000229471 ) on 19 February 2016 (retrospectively registered). Secondary identifiers: MODERN is an investigator-initiated trial funded by the National Health and Medical Research Council of Australia from 2014 to 2017 via a Project Grant (ID No. APP1069043) and was approved by the Australian Catholic University Human Research Ethics Committee (Project No: 2014 244 V) and the Department of Health Human Research Ethics Committee (Project No:38/2014) for the release of Medicare claims information.

Noninsulin Diabetes Medications.

Pharmacotherapy for diabetes has changed greatly owing to drugs and drug classes available. There are 11 classes of noninsulin diabetes medications available in the United States. With the use of 1 drug alone or in combination with different drugs, it is possible to improve glycemic control in patients with diabetes. Important properties of antidiabetic agents play a role in the choice of that particular medication for individual patients. Prescribing a diabetes medication regimen is based careful assessment of patient needs, and consideration of the medication's efficacy, impact on weight, hypoglycemia risk, potential side effects, cost, and patient preferences.

[Social inequalities, chronic diseases and therapeutic patient education]. / Inégalités sociales, maladies chroniques et ETP.

A study was carried out of patients with type 2 diabetes following a hospital therapeutic education programme. The results show that the transfer of self-management and adaptation competencies must take into consideration patients' social differentiation. They bring into question the assumption of the individual's autonomy. In this context, the professional position of the caregivers is essential in order to provide patients with the best support possible.

Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care.

BACKGROUND: The burden of chronic disease and multimorbidity is rapidly increasing. Self-management support interventions are effective in reduce cost, especially when targeted at a single disease group; however, economical evidence of such complex interventions remains scarce. The objective of this study was to evaluate a cost-effectiveness analysis of a tele-based health-coaching intervention among patients with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). METHODS: A total of 1570 patients were blindly randomized to intervention (n = 970) and control (n = 470) groups. The intervention group received monthly individual health coaching by telephone from a specially trained nurse for 12-months in addition to routine social and healthcare. Patients in the control group received routine social and health care. Quality of life was assessed at the beginning of the intervention and follow-up measurements were made after 12 months health coaching. The cost included all direct health-care costs supplemented with home care and nursing home-care costs in social care. Utility was based on a Health Related Quality of Life (HRQoL) measurement (15D instrument), and cost effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). RESULTS: The cost-effectiveness of health coaching was highest in the T2D group (ICER €20,000 per Quality-Adjusted Life Years [QALY]). The ICER for the CAD group was more modest (€40,278 per QALY), and in the CHF group, costs increased with no marked effect on QoL. Probabilistic sensitivity analysis indicated that at the societal willingness to pay threshold of €50,000 per QALY, the probability of health coaching being cost effective was 55% in the whole study group. CONCLUSIONS: The cost effectiveness of health coaching may vary substantially across patient groups, and thus interventions should be targeted at selected subgroups of chronically ill. Based on the results of this study, health coaching improved the QoL of T2D and CAD patients with moderate costs. However, the results are grounded on a short follow-up period, and more evidence is needed to evaluate the long-term outcomes of health-coaching programs. TRIAL REGISTRATION: NCT00552903 [Prospectively registered, registration date 1st November 2007, last updated 3rd February 2009].

The ACHRU-CPP versus usual care for older adults with type-2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial.

BACKGROUND: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends). METHODS/DESIGN: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration. DISCUSSION: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014.

Programa de gerenciamento de doenças crônicas em um plano de saúde, são paulo, brasil / Programa de gestión de enfermedades crónicas en un seguro salud en el estado de são paulo, brasil / Chronic disease management program in a health plan, são paulo, brazil

RESUMO Atualmente as doenças crônicas não transmissíveis são as principais causas de morte no mundo. Consideradas doenças multifatoriais, têm em comum fatores de riscos modificáveis tais como inatividade física, colesterol elevado, excesso de peso, tabagismo, consumo excessivo de bebidas alcoólicas e alimentação não saudável. Com o objetivo de verificar o impacto por um programa de Gerenciamento de Doenças Crônicas, após dois anos de acompanhamento, surgiu esta pesquisa. Trata-se de programa desenvolvido com um grupo de clientes de uma autogestão localizada no estado de São Paulo. É um estudo transversal realizado durante os anos de 2014-2015 com dados de prontuário eletrônico que foram comparados parâmetros clínicos e hábitos de vida de 1.509 indivíduos participantes de um programa de gerenciamento de doenças em dois momentos: na entrada ao programa e após dois anos de participação. Observaram-se resultados satisfatórios na melhora de parâmetros clínicos relacionados aos níveis pressóricos e à dosagem de glicemia em jejum, assim como diminuição do sedentarismo em indivíduos abaixo dos 60 anos.

RESUMEN Actualmente las enfermedades crónicas no transmisibles son las principales causas de muerte en todo el mundo. Consideradas enfermedades multifactoriales, tienen en común factores de riesgo modificables, tales como inactividad física, colesterol alto, sobrepeso, tabaco, exceso de alcohol y alimentación poco sana. Con el objetivo de averiguar el impacto por un programa de Gestión de Enfermedades Crónicas, tras dos años de acompañamiento, se hizo esta investigación. Se trata de un programa desarrollado con un grupo de clientes de una autogestión ubicada en el estado de São Paulo, Brasil. Es un estudio transversal realizado durante los años de 2014-2015 con datos de registros médicos electrónicos, comparándose los parámetros clínicos y hábitos de vida de 1.509 personas que participan en un programa de gestión de enfermedades en dos ocasiones: cuando entran en el programa y después de dos años de participación. Se observaron resultados satisfactorios en la mejora de los parámetros clínicos relacionados con los niveles de presión arterial y a la dosificación de glucemia en ayunas, así como la disminución de la inactividad física en personas con edad abajo de 60 años.

ABSTRACT Currently, non-transmissible chronic diseases are leading causes of death worldwide. Considered as multifactorial diseases, they have common modifiable risk factors such as physical inactivity, high cholesterol, overweight, smoking, excessive alcohol consumption, and unhealthy diets. Aiming at verifying the impact of theChronic Disease Management program, this study arose after two years of follow-up. This is a program developed with a group of customers in a self-management platform in the state of São Paulo. This was a cross-sectional study carried out during 2014 and 2015 with electronic medical record data through the comparison ofthe clinical and lifestyle parameters of 1,509 individuals participating in a disease management program in two moments: at the program'sentry and two years after participation. Satisfactory results in the improvement of clinical parameters related to blood pressure and blood glucose levels in fasting were observed as well as decreased physical inactivity in individuals under 60 years of age.

Psychological skills training to support diabetes self-management: Qualitative assessment of nurses' experiences.

AIM: Evidence for the efficacy of psychological skills training as a method of supporting patients' self-management is growing, but there is a shortage of mental health providers with specialist diabetes knowledge to deliver them. Primary care nurses are now increasingly expected to learn and use these techniques. This study explores nurse experience of training in six psychological skills to support patients' self-management of type 2 diabetes. METHODS: Semi-structured interviews elicited themes relating to nurses' experiences of participating in a trial of a psychological intervention, the Diabetes-6 study (D-6). Nurses were employed in GP surgeries in 5 South London boroughs. Thematic framework analysis was used to compare and contrast themes across participants. Nine nurses delivering the intervention (n=11), and 7 from the control intervention (n=12, no psychological element) were interviewed. RESULTS: Three key themes were identified: (i) positive and negative impact of D6 on nurses' practice: positives included patient empowerment; negatives included patients' capacity to engage; (ii) professional boundaries including concerns about over-stepping role as a nurse and (iii) concerns about degree of support from physicians at participating practices in integrating psychological and diabetes care. CONCLUSION: Primary care nurses report that psychological skills training can have a positive impact on patient care. Significant role adjustment is required, which may be aided by additional support from the practice team. Qualitative evaluation of effectiveness of psychological interventions may reveal processes that hinder or contribute to efficacy and translation. Appropriate support is necessary for primary care nurses to deliver psychological therapies with confidence.

A Spanish-Language Risk Perception Survey for Developing Diabetes: Translation Process and Assessment of Psychometric Properties.

BACKGROUND AND PURPOSE: Create a Spanish-language version of the Risk Perception Survey for Developing Diabetes (RPS-DD) and assess psychometric properties. RESEARCH DESIGN AND METHODS: The Spanish-language version was created through translation, harmonization, and presentation to the tool's original author. It was field tested in a foreignborn Latino sample and properties evaluated in principal components analysis. RESULTS: Personal Control, Optimistic Bias, and Worry multi-item Likert subscale responses did not cluster together. A clean solution was obtained after removing two Personal Control subscale items. Neither the Personal Disease Risk scale nor the Environmental Health Risk scale responses loaded onto single factors. Reliabilities ranged from .54 to .88. Test of knowledge performance varied by item. CONCLUSIONS: This study contributes to evidence of validation of a Spanish-language RPS-DD in foreign-born Latinos.

RN Diabetes Virtual Case Management: A New Model for Providing Chronic Care Management.

The U.S. chronic disease health care system has substantial gaps in delivery of services. New models of care change traditional delivery of care and explore new settings for care. This article describes a new model of diabetes chronic care delivery: nurse-delivered care that includes protocol-based insulin titration and patient education delivered solely in a virtual environment. In phase 1, the clinical outcome of time to achievement of glycated hemoglobin (A(1C)) goals (P < .001; 95% confidence interval, 1.68-2.24) was significantly improved by registered nurse (RN) standing order intervention (n = 24) as compared with historical controls (n = 28). In phase 2, patients who were referred to an RN-managed insulin titration protocol with individualized A(1C) goals had a significant (P < .001; 95% confidence interval, 1.680-2.242) reduction in results from a mean of 9.6% at baseline to 7.7% at completion. Average patient age was 66 years, with a mean duration of 11 years diagnosed with diabetes. Safety was demonstrated by the absence of hypoglycemia related to RN protocol adjustment. There were no admissions or emergency room (ER) visits for hypoglycemia. This study demonstrates safety and efficacy of RN virtual chronic disease management for an older population of patients with long-standing diabetes.

Assessment of Insulin Administration Methods: Perceptions by Patients and Significant Others Instrument Development.

BACKGROUND AND PURPOSE: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. METHODS: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. RESULTS: Validity and reliability were established. CONCLUSIONS: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.

Managing type 2 diabetes in Black patients.

Despite many novel treatments available for managing type 2 diabetes mellitus, Black patients continue to disproportionately suffer complications associated with poor glycemic control. This article describes a comprehensive approach to managing diabetes mellitus in these patients while addressing cultural nuances that may be barriers to positive outcomes.